Provider Demographics
NPI:1790926293
Name:MAXIMUM MOBILITY CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:MAXIMUM MOBILITY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TECUMSEH WALLACE
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-659-6020
Mailing Address - Street 1:70 N MCCLINTOCK DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3711
Mailing Address - Country:US
Mailing Address - Phone:480-659-6020
Mailing Address - Fax:480-659-8544
Practice Address - Street 1:70 N MCCLINTOCK DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3711
Practice Address - Country:US
Practice Address - Phone:480-659-6020
Practice Address - Fax:480-659-8544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7437111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V02608Medicare UPIN