Provider Demographics
NPI:1306029012
Name:MAXIMUM CHIROPRACTIC
Entity Type:Organization
Organization Name:MAXIMUM CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-840-2868
Mailing Address - Street 1:590 INDIAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3600
Mailing Address - Country:US
Mailing Address - Phone:724-465-2230
Mailing Address - Fax:724-465-2235
Practice Address - Street 1:590 INDIAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3600
Practice Address - Country:US
Practice Address - Phone:724-465-2230
Practice Address - Fax:724-465-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009873111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty