Provider Demographics
NPI:1326472911
Name:MAXIMIZED CHIROPRACTIC
Entity Type:Organization
Organization Name:MAXIMIZED CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-751-6000
Mailing Address - Street 1:2000 N 12TH ST # 101
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1905
Mailing Address - Country:US
Mailing Address - Phone:701-751-6000
Mailing Address - Fax:
Practice Address - Street 1:2000 N 12TH ST # 101
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1905
Practice Address - Country:US
Practice Address - Phone:701-751-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty