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General NPI Number Information
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NPI Number | 1578743761
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Entity Type | Organization
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Legal Business Name | MAXIMUM POTENTIAL CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 155 NORTHLAND DR
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City | MEDINA
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State | OH
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Zip | 44256-1534
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Country | US
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Telephone | 330-723-1441
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Fax | 330-723-1881
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Provider Business Mailing Address
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Address Line | 155 NORTHLAND DR
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City | MEDINA
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State | OH
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Zip | 44256-1534
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Country | US
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Telephone | 330-723-1441
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Fax | 330-723-1881
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MRS. RAE JASMINE HAMILTON
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Credential |
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Telephone | 330-723-1441
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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 | DC.3602
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License Number State | OH
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