Provider Demographics
NPI:1477622942
Name:MAYNARD, RICHARD J JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:MAYNARD
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:J
Other - Last Name:MAYNARD
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:784 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3983
Mailing Address - Country:US
Mailing Address - Phone:740-687-0100
Mailing Address - Fax:740-687-0145
Practice Address - Street 1:784 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3983
Practice Address - Country:US
Practice Address - Phone:740-687-0100
Practice Address - Fax:740-687-0145
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3214111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2283603Medicaid
OHP00465005OtherRAILROAD MEDICARE
OH31-0991279OtherTAX ID
OH4062981Medicare ID - Type UnspecifiedMEDICARE ID
OH31-0991279OtherTAX ID