Provider Demographics
NPI:1164192605
Name:MAYNARD, HALDEN P (DC)
Entity Type:Individual
Prefix:
First Name:HALDEN
Middle Name:P
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 W WHITE OAK TER STE A
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3675
Mailing Address - Country:US
Mailing Address - Phone:936-253-5314
Mailing Address - Fax:936-253-1035
Practice Address - Street 1:3466 DISCOVERY CREEK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-7126
Practice Address - Country:US
Practice Address - Phone:281-367-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor