Provider Demographics
NPI:1265730766
Name:WALDREN, JAMES (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WALDREN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1778
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1778
Mailing Address - Country:US
Mailing Address - Phone:207-241-8239
Mailing Address - Fax:207-241-8240
Practice Address - Street 1:444 STILLWATER AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3521
Practice Address - Country:US
Practice Address - Phone:207-992-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor