MEDICARE: MAXIMIZED LIVING FOUNDATION, 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
1	111N00000X	Chiropractor	32810	CA

General Provider Information

NPI Number	:	1659785079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIMIZED LIVING FOUNDATION, INC

Provider Business Mailing Address
First Line	:	1170 CELEBRATION BLVD STE 100B
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-4604
Country	:	US
Telephone Number	:	321-939-3042
Fax Number	:	321-939-3061

Provider Business Practice Location Address
First Line	:	2301 BELLEVUE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4017
Country	:	US
Telephone Number	:	213-273-7000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT JOHN RAMSEY
Credential	:
Telephone Number	:	321-939-3042

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	06/13/2014

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