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General NPI Number Information
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NPI Number | 1275729493
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Entity Type | Organization
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Legal Business Name | AZ MAYNARD CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 20260 N 59TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85308-6845
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Country | US
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Telephone | 623-561-9111
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Fax | 623-561-0005
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Provider Business Mailing Address
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Address Line | 17174 W LAIRD CT
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City | SURPRISE
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State | AZ
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Zip | 85387-4204
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Country | US
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Telephone | 623-570-3431
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. LAUREN MICHELLE MAYNARD
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Credential | D.C.
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Telephone | 623-570-3431
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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 | 7847
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License Number State | AZ
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