Provider Demographics
NPI:1851463582
Name:MAXCARE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MAXCARE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAZAROFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-482-7246
Mailing Address - Street 1:PO BOX 4609
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-0609
Mailing Address - Country:US
Mailing Address - Phone:215-482-6020
Mailing Address - Fax:
Practice Address - Street 1:4151 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19127-2115
Practice Address - Country:US
Practice Address - Phone:215-482-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA083799S75Medicare ID - Type Unspecified