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NPI Code Detail

MEDICARE: MAXIMUM POTENTIAL CHIROPRACTIC, INC.

MEDICARE: MAXIMUM POTENTIAL CHIROPRACTIC, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorDC.3602OH

General Provider Information

NPI Number : 1578743761
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAXIMUM POTENTIAL CHIROPRACTIC, INC.
Provider Business Mailing Address
First Line : 155 NORTHLAND DR
Second Line :
City : MEDINA
State : OH
Zip : 44256-1534
Country : US
Telephone Number : 330-723-1441
Fax Number : 330-723-1881
Provider Business Practice Location Address
First Line : 155 NORTHLAND DR
Second Line :
City : MEDINA
State : OH
Zip : 44256-1534
Country : US
Telephone Number : 330-723-1441
Fax Number : 330-723-1881
Authorized Official
Title or Position : CLINIC DIRECTOR
Name : MRS. RAE JASMINE HAMILTON
Credential :
Telephone Number : 330-723-1441
Provider Enumeration Date : 11/06/2007
Last Update Date : 09/28/2011

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Directions to “MAXIMUM POTENTIAL CHIROPRACTIC, INC. ” Practice Location

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