Provider Demographics
NPI:1043576028
Name:MAXWELL, WILLIAM ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:13501 RANCH ROAD 12
Mailing Address - Street 2:STE 111
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5328
Mailing Address - Country:US
Mailing Address - Phone:512-270-8057
Mailing Address - Fax:512-326-1355
Practice Address - Street 1:13501 RANCH ROAD 12
Practice Address - Street 2:SUITE 111
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5353
Practice Address - Country:US
Practice Address - Phone:512-270-8057
Practice Address - Fax:512-326-1355
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB156038Medicare UPIN