Provider Demographics
NPI:1578743761
Name:MAXIMUM POTENTIAL CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MAXIMUM POTENTIAL CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAE
Authorized Official - Middle Name:JASMINE
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-723-1441
Mailing Address - Street 1:155 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1534
Mailing Address - Country:US
Mailing Address - Phone:330-723-1441
Mailing Address - Fax:330-723-1881
Practice Address - Street 1:155 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1534
Practice Address - Country:US
Practice Address - Phone:330-723-1441
Practice Address - Fax:330-723-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC.3602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9355351Medicare PIN