Provider Demographics
NPI:1568058287
Name:POWIADA, MAXIM (DC)
Entity Type:Individual
Prefix:DR
First Name:MAXIM
Middle Name:
Last Name:POWIADA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19120 N PIMA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5391
Mailing Address - Country:US
Mailing Address - Phone:503-701-8147
Mailing Address - Fax:
Practice Address - Street 1:19120 N PIMA RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5391
Practice Address - Country:US
Practice Address - Phone:503-701-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8990111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician