Provider Demographics
NPI:1316318702
Name:HARTWELL, MAVERIC (DC)
Entity type:Individual
Prefix:DR
First Name:MAVERIC
Middle Name:
Last Name:HARTWELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 N VENTURA AVE
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-4134
Mailing Address - Country:US
Mailing Address - Phone:818-648-2610
Mailing Address - Fax:
Practice Address - Street 1:11400 N VENTURA AVE
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-4134
Practice Address - Country:US
Practice Address - Phone:818-648-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33391111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation