Provider Demographics
NPI:1508061250
Name:FREEPORT INTEGRATED HEALTH CENTER, P.A.
Entity Type:Organization
Organization Name:FREEPORT INTEGRATED HEALTH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-865-1183
Mailing Address - Street 1:174 S FREEPORT RD
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6145
Mailing Address - Country:US
Mailing Address - Phone:207-865-1183
Mailing Address - Fax:207-865-1183
Practice Address - Street 1:174 S FREEPORT RD
Practice Address - Street 2:SUITE 1F
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6145
Practice Address - Country:US
Practice Address - Phone:207-865-1183
Practice Address - Fax:207-865-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME038032OtherAETNA
ME133220099Medicaid
ME9332788OtherCIGNA
ME1492459OtherANTHEM
ME133220099Medicaid
MEU78062Medicare UPIN