MEDICARE: MAX WELLNESS LLC

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

General Provider Information

NPI Number	:	1760195846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAX WELLNESS LLC

Provider Business Mailing Address
First Line	:	924 MORGAN ST
Second Line	:
City	:	BELLE VERNON
State	:	PA
Zip	:	15012-2167
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PEASANT VILLAGE LN STE 101
Second Line	:
City	:	ROSTRAVER TOWNSHIP
State	:	PA
Zip	:	15012-4333
Country	:	US
Telephone Number	:	407-402-2376
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	MATTHEW COURY
Credential	:	DC
Telephone Number	:	407-402-2376

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/03/2023

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Directions to “MAX WELLNESS LLC ” Practice Location

Language	Start Address	Practice Location

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