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General NPI Number Information
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NPI Number | 1659622553
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Entity Type | Organization
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Legal Business Name | MAXFIELD ENTERPRISE
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 7123 CROSSROADS BLVD SUITE A
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City | BRENTWOOD
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State | TN
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Zip | 37027-2877
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Country | US
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Telephone | 615-656-3558
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Fax |
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Provider Business Mailing Address
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Address Line | 7123 CROSSROADS BLVD SUITE A
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City | BRENTWOOD
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State | TN
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Zip | 37027-2877
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Country | US
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Telephone | 615-656-3558
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROLYN MAXFIELD
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Credential | D.C.
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Telephone | 419-957-2057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 2625
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License Number State | TN
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