=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659785079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXIMIZED LIVING FOUNDATION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2014
-----------------------------------------------------
Last Update Date | 06/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 BELLEVUE AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90026-4017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-273-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1170 CELEBRATION BLVD STE 100B
-----------------------------------------------------
City | CELEBRATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34747-4604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-939-3042
-----------------------------------------------------
Fax | 321-939-3061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROBERT JOHN RAMSEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-939-3042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 32810
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------