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General NPI Number Information
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NPI Number | 1578753836
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Entity Type | Organization
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Legal Business Name | JADE TRADE INC.
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 1023 WASHINGTON AVE
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City | PORTLAND
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State | ME
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Zip | 04103-2793
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Country | US
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Telephone | 207-773-5778
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Fax | 207-773-5773
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Provider Business Mailing Address
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Address Line | 1023 WASHINGTON AVE
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City | PORTLAND
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State | ME
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Zip | 04103-2793
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Country | US
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Telephone | 207-773-5778
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Fax | 207-773-5773
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | KESIA CAMPBELL
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Credential |
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Telephone | 207-747-5746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC200
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT1458
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2432
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License Number State |
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