MEDICARE: DR. JOHN MAHER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor	12754	CA

General Provider Information

NPI Number	:	1205991213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MAHER D.C.

Provider Business Mailing Address
First Line	:	30523 TERRACE VIEW LN
Second Line	:
City	:	VALLEY CENTER
State	:	CA
Zip	:	92082-5256
Country	:	US
Telephone Number	:	858-342-1614
Fax Number	:	760-751-3559

Provider Business Practice Location Address
First Line	:	28714 VALLEY CENTER RD
Second Line	:	SUITE I
City	:	VALLEY CENTER
State	:	CA
Zip	:	92082-6554
Country	:	US
Telephone Number	:	760-500-6253
Fax Number	:	760-751-3559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	04/13/2015

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