Provider Demographics
NPI:1992933196
Name:HERSEY, JENNIE LOIS (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:LOIS
Last Name:HERSEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1060
Mailing Address - Country:US
Mailing Address - Phone:207-780-1070
Mailing Address - Fax:207-780-1007
Practice Address - Street 1:949 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1060
Practice Address - Country:US
Practice Address - Phone:207-780-1070
Practice Address - Fax:207-780-1007
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program