Provider Demographics
NPI:1669660718
Name:MAXWELL CHIROPRACTIC SERVICES, P.A.
Entity Type:Organization
Organization Name:MAXWELL CHIROPRACTIC SERVICES, P.A.
Other - Org Name:REVELATIONS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMEY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-273-2415
Mailing Address - Street 1:619 DEAHL ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-3519
Mailing Address - Country:US
Mailing Address - Phone:806-273-2415
Mailing Address - Fax:806-273-2715
Practice Address - Street 1:619 DEAHL ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-3519
Practice Address - Country:US
Practice Address - Phone:806-273-2415
Practice Address - Fax:806-273-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty