Healthcare Provider Details

I. General information

NPI: 1497594816
Provider Name (Legal Business Name): MAXRELAX ZEN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23646 ROCKFIELD BLVD STE 601
LAKE FOREST CA
92630-1688
US

IV. Provider business mailing address

1309 COFFEEN AVE STE 14130, C/O RAJEUNVIE
SHERIDAN WY
82801-5777
US

V. Phone/Fax

Practice location:
  • Phone: 307-228-1551
  • Fax:
Mailing address:
  • Phone: 307-228-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: GUIQIN ANN
Title or Position: MANAGER
Credential:
Phone: 307-228-1551