Organization
MAXIM CHIROPRACTIC TWO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN FOSSUM (MANAGER)
(480) 222-5170
Entity
Organization
Contact information
Practice address
1337 S GILBERT RD, SUITE 105, MESA, AZ 85204-6073
(480) 635-1718
Mailing address
1830 S ALMA SCHOOL RD, SUITE 116, MESA, AZ 85210-3056
(480) 635-1718
(480) 635-1719
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0447360
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
01/22/2007
Last updated
08/22/2020
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