Provider Demographics
NPI:1952647901
Name:MIDCOAST INTEGRATIVE HEALTHCARE
Entity type:Organization
Organization Name:MIDCOAST INTEGRATIVE HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-798-9677
Mailing Address - Street 1:14 MAINE ST
Mailing Address - Street 2:SUITE 205, BOX 14
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2049
Mailing Address - Country:US
Mailing Address - Phone:207-798-9677
Mailing Address - Fax:207-406-2029
Practice Address - Street 1:14 MAINE ST
Practice Address - Street 2:SUITE 205, BOX 14
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2049
Practice Address - Country:US
Practice Address - Phone:207-798-9677
Practice Address - Fax:207-406-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty