Provider Demographics
NPI:1013561760
Name:MAVERICK CHIROPRACTIC PLC
Entity Type:Organization
Organization Name:MAVERICK CHIROPRACTIC PLC
Other - Org Name:MAVERICK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:REES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-737-1046
Mailing Address - Street 1:1133 WAYZATA BLVD E STE B
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1950
Mailing Address - Country:US
Mailing Address - Phone:952-737-1046
Mailing Address - Fax:
Practice Address - Street 1:1133 WAYZATA BLVD E STE B
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1950
Practice Address - Country:US
Practice Address - Phone:952-737-1046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty