Provider Demographics
NPI:1225048044
Name:MAXWELL, TREVOR W (DC)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:W
Last Name:MAXWELL
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 1:141 E INDIANA AV STE B
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-4329
Mailing Address - Country:US
Mailing Address - Phone:386-734-2522
Mailing Address - Fax:386-734-2502
Practice Address - Street 1:141 E INDIANA AV STE B
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-4329
Practice Address - Country:US
Practice Address - Phone:386-734-2522
Practice Address - Fax:386-734-2502
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAO988ZOtherMEDICARE ID-PTAN
FL381396700Medicaid
FL53880OtherBLUE CROSS BLUE SHIELD
U832390001Medicare UPIN
FL53880OtherBLUE CROSS BLUE SHIELD