Organization
MAXIM CHIROPRACTIC AND REHABILITATION CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN FOSSUM (MANAGEMENT)
(480) 222-5170
Entity
Organization
Contact information
Practice address
1840 E WARNER RD, SUITE 122, TEMPE, AZ 85284-3437
(480) 755-1718
Mailing address
1830 S ALMA SCHOOL RD, SUITE 116, MESA, AZ 85210-3056
(480) 222-5163
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0931560
BLUE CROSS BLUE SHIELD
AZ
01
—
AZ0936660
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
01/22/2007
Last updated
10/16/2007
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