Provider Demographics
NPI:1275729493
Name:AZ MAYNARD CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:AZ MAYNARD CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-570-3431
Mailing Address - Street 1:17174 W LAIRD CT
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-4204
Mailing Address - Country:US
Mailing Address - Phone:623-570-3431
Mailing Address - Fax:
Practice Address - Street 1:20260 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6845
Practice Address - Country:US
Practice Address - Phone:623-561-9111
Practice Address - Fax:623-561-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty