=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386001659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN H MAHER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2016
-----------------------------------------------------
Last Update Date | 01/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28714 VALLEY CENTER RD STE I
-----------------------------------------------------
City | VALLEY CENTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92082-6512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-500-6253
-----------------------------------------------------
Fax | 760-751-3559
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30523 TERRACE VIEW LN
-----------------------------------------------------
City | VALLEY CENTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92082-5256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-500-6253
-----------------------------------------------------
Fax | 760-751-3559
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN H MAHER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 760-500-6253
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 12754
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------