Provider Demographics
NPI:1447331202
Name:MAYNES, JOHN ROSSALL (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROSSALL
Last Name:MAYNES
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 1:110 S CITRUS AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6066
Mailing Address - Country:US
Mailing Address - Phone:760-726-7091
Mailing Address - Fax:760-726-7903
Practice Address - Street 1:110 S CITRUS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6066
Practice Address - Country:US
Practice Address - Phone:760-726-7091
Practice Address - Fax:760-726-7903
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 19532111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19532OtherCALIFORNIA D.C. LICENSE #