Provider Demographics
NPI:1427397421
Name:MAXWELL, JESSIE S (LAC)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:S
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8471 TURNPIKE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-4387
Mailing Address - Country:US
Mailing Address - Phone:303-425-4825
Mailing Address - Fax:
Practice Address - Street 1:8471 TURNPIKE DR
Practice Address - Street 2:STE 200
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-4387
Practice Address - Country:US
Practice Address - Phone:303-425-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist