Provider Demographics
NPI:1861564510
Name:MAYWALD, CHRISTOPH (DC)
Entity type:Individual
Prefix:
First Name:CHRISTOPH
Middle Name:
Last Name:MAYWALD
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 1:887 WASHINGTON STREET
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189
Mailing Address - Country:US
Mailing Address - Phone:781-331-8282
Mailing Address - Fax:781-331-7371
Practice Address - Street 1:884 WASHINGTON ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-1530
Practice Address - Country:US
Practice Address - Phone:781-331-8282
Practice Address - Fax:781-331-7371
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35284Medicare ID - Type Unspecified