Provider Demographics
NPI:1164550414
Name:MAXWELL, DAPHNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:STE 301N
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:630-320-6400
Mailing Address - Fax:630-701-1007
Practice Address - Street 1:899 S WEBER RD
Practice Address - Street 2:STE D
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-5488
Practice Address - Country:US
Practice Address - Phone:630-771-9496
Practice Address - Fax:630-771-0361
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3347111N00000X
IL038011974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2459444Medicare PIN
NC085XPOtherBCBS