Healthcare Provider Details

I. General information

NPI: 1306483052
Provider Name (Legal Business Name): MAYA ANN EZER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAYA ANN DOROSCHAK D.C.

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 RICE STREET N
SAINT PAUL MN
55126
US

IV. Provider business mailing address

3454 RICE STREET N
SAINT PAUL MN
55126
US

V. Phone/Fax

Practice location:
  • Phone: 651-483-4321
  • Fax: 651-483-3440
Mailing address:
  • Phone: 651-483-4321
  • Fax: 651-483-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6672
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: