Provider Demographics
NPI:1093910598
Name:MAHARAJ CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:MAHARAJ CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:YANEIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAHARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-745-3578
Mailing Address - Street 1:95 ARGONAUT
Mailing Address - Street 2:280
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4133
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:
Practice Address - Street 1:925 E PENNSYLVANIA AVE
Practice Address - Street 2:A
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3432
Practice Address - Country:US
Practice Address - Phone:760-745-3578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64945ZOtherBLUE SHIELD
CAW19701Medicare ID - Type UnspecifiedGROUP ID
CAZZZ64945ZOtherBLUE SHIELD
CAWDC28262AMedicare ID - Type Unspecified