Provider Demographics
NPI:1225293426
Name:CENTER FOR MAXIMIZED LIVING, LLC
Entity Type:Organization
Organization Name:CENTER FOR MAXIMIZED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-278-2782
Mailing Address - Street 1:8671 NORTHPARK CT.
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131
Mailing Address - Country:US
Mailing Address - Phone:515-278-2782
Mailing Address - Fax:515-278-0194
Practice Address - Street 1:8671 NORTHPARK CT.
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131
Practice Address - Country:US
Practice Address - Phone:515-278-2782
Practice Address - Fax:515-278-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA07055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty