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General NPI Number Information
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NPI Number | 1164192605
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Entity Type | Individual
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Provider Name | HALDEN P MAYNARD DC
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Gender | Male
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 125 BLUE HERON DR STE B
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City | MONTGOMERY
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State | TX
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Zip | 77316-3183
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Country | US
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Telephone | 936-582-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 1803 W WHITE OAK TER STE A
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City | CONROE
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State | TX
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Zip | 77304-3675
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Country | US
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Telephone | 936-253-5314
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Fax | 936-253-1035
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 14336
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License Number State | TX
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