Provider Demographics
NPI:1407101280
Name:MAPLE LEAF PC
Entity Type:Organization
Organization Name:MAPLE LEAF PC
Other - Org Name:ARIZONA SPINAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DARVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-513-9580
Mailing Address - Street 1:8360 E RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2686
Mailing Address - Country:US
Mailing Address - Phone:480-513-9580
Mailing Address - Fax:480-513-9579
Practice Address - Street 1:8360 E RAINTREE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2686
Practice Address - Country:US
Practice Address - Phone:480-513-9580
Practice Address - Fax:480-513-9579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ-10544Medicare UPIN