Healthcare Provider Details

I. General information

NPI: 1447331202
Provider Name (Legal Business Name): JOHN ROSSALL MAYNES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S CITRUS AVE SUITE C
VISTA CA
92084-6066
US

IV. Provider business mailing address

110 S CITRUS AVE SUITE C
VISTA CA
92084-6066
US

V. Phone/Fax

Practice location:
  • Phone: 760-726-7091
  • Fax: 760-726-7903
Mailing address:
  • Phone: 760-726-7091
  • Fax: 760-726-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC 19532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: