MEDICARE: MAXLIFE HEALTH AND WELLNESS CENTER

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	111N00000X	Chiropractor	CH 9026	FL

General Provider Information

NPI Number	:	1326069485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXLIFE HEALTH AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	425 ALEXANDRIA BLVD
Second Line	:	SUITE 1010
City	:	OVIEDO
State	:	FL
Zip	:	32765-5548
Country	:	US
Telephone Number	:	407-977-3434
Fax Number	:	407-977-3433

Provider Business Practice Location Address
First Line	:	425 ALEXANDRIA BLVD
Second Line	:	SUITE 1010
City	:	OVIEDO
State	:	FL
Zip	:	32765-5548
Country	:	US
Telephone Number	:	407-977-3434
Fax Number	:	407-977-3433

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MARC G OTT
Credential	:
Telephone Number	:	407-977-3434

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	09/14/2011

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Directions to “MAXLIFE HEALTH AND WELLNESS CENTER ” Practice Location

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