Provider Demographics
NPI:1366730178
Name:MAINE INTEGRATIVE CHIROPRACTIC
Entity type:Organization
Organization Name:MAINE INTEGRATIVE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER D.C.
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-338-8994
Mailing Address - Street 1:8 JESSE ROBBINS RD
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7510
Mailing Address - Country:US
Mailing Address - Phone:207-338-8994
Mailing Address - Fax:207-338-0198
Practice Address - Street 1:8 JESSE ROBBINS RD
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7510
Practice Address - Country:US
Practice Address - Phone:207-338-8994
Practice Address - Fax:207-338-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty