1225446586 NPI number — HAROLDSON HEALTH SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225446586 NPI number — HAROLDSON HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAROLDSON HEALTH SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TEN LAKES CHIROPRACTIC CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225446586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04009-0020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 PORTLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04009-4227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-647-9900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2014

Additional Information

Authorized Official

Authorized Official Last Name:
EAGAN
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MANAGING MEMBER
Authorized Official Telephone Number:
207-647-9900

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CR 1910 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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