Provider Demographics
NPI:1427144112
Name:HUDSON-FRIDGEN, BLAIR EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:EUGENE
Last Name:HUDSON-FRIDGEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BLAIR
Other - Middle Name:EUGENE
Other - Last Name:FRIDGEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:171 US RT 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-883-1515
Mailing Address - Fax:207-883-1536
Practice Address - Street 1:171 US RT 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-883-1515
Practice Address - Fax:207-883-1536
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME119800000Medicaid
MEMM2145Medicare ID - Type Unspecified