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General NPI Number Information
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NPI Number | 1659794790
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Entity Type | Organization
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Legal Business Name | MAXLIFE CHIROPRACTIC
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Dates
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Enumeration Date | 01/25/2014
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | 9865 E 116TH ST STE 150
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City | FISHERS
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State | IN
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Zip | 46037-9239
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Country | US
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Telephone | 317-808-5675
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Fax |
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Provider Business Mailing Address
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Address Line | 9865 E 116TH ST STE 150
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City | FISHERS
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State | IN
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Zip | 46037-9239
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Country | US
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Telephone | 317-808-5675
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. JASON GRANT HARRISON
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Credential | D.C.
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Telephone | 317-808-5675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 08002304A
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License Number State | IN
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