Provider Demographics
NPI:1093573842
Name:METTLER, MAXAMILLION ANTHONY (LCP, DC)
Entity Type:Individual
Prefix:DR
First Name:MAXAMILLION
Middle Name:ANTHONY
Last Name:METTLER
Suffix:
Gender:M
Credentials:LCP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 YELLOWSTONE RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4736
Mailing Address - Country:US
Mailing Address - Phone:307-632-3525
Mailing Address - Fax:
Practice Address - Street 1:5231 YELLOWSTONE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4736
Practice Address - Country:US
Practice Address - Phone:307-632-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor