Provider Demographics
NPI:1497083497
Name:MAVERICK DC PLLC
Entity Type:Organization
Organization Name:MAVERICK DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-471-1289
Mailing Address - Street 1:1720 S 72ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-1299
Mailing Address - Country:US
Mailing Address - Phone:253-471-1289
Mailing Address - Fax:253-471-1290
Practice Address - Street 1:1720 S 72ND ST STE 201
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1299
Practice Address - Country:US
Practice Address - Phone:253-471-1289
Practice Address - Fax:253-471-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty