Provider Demographics
NPI:1083067375
Name:MAXIMUM WELLNESS CHIROPRACTIC
Entity Type:Organization
Organization Name:MAXIMUM WELLNESS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-270-8057
Mailing Address - Street 1:4701 MONTEREY OAKS BLVD APT 914
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-0905
Mailing Address - Country:US
Mailing Address - Phone:512-270-8057
Mailing Address - Fax:
Practice Address - Street 1:14500 RANCH ROAD 12
Practice Address - Street 2:STE 4
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-6218
Practice Address - Country:US
Practice Address - Phone:512-270-8057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty