Individual
MAXIM I IVANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
401 E MADISON ST, GOSHEN, IN 46526-3431
(574) 533-7363
Mailing address
401 E MADISON ST, GOSHEN, IN 46526-3431
(574) 533-7363
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08002243A
IN
Other
Enumeration date
10/10/2006
Last updated
07/08/2007
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