Provider Demographics
NPI:1497078638
Name:TMAXDC, INC
Entity Type:Organization
Organization Name:TMAXDC, INC
Other - Org Name:IIIAXLIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT TMAX DC, INC
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MAXIMOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-292-0222
Mailing Address - Street 1:250 MAIN STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940
Mailing Address - Country:US
Mailing Address - Phone:973-292-0222
Mailing Address - Fax:973-575-7159
Practice Address - Street 1:250 MAIN STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940
Practice Address - Country:US
Practice Address - Phone:973-292-0222
Practice Address - Fax:973-236-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
083733Medicare UPIN