Provider Demographics
NPI:1326744749
Name:MAXSON, CHRISTOPHER MCRAE JR
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MCRAE
Last Name:MAXSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 TYRONE BLVD N STE 101
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4114
Mailing Address - Country:US
Mailing Address - Phone:727-440-2770
Mailing Address - Fax:727-256-0344
Practice Address - Street 1:3831 TYRONE BLVD N STE 101
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4114
Practice Address - Country:US
Practice Address - Phone:847-528-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor