Provider Demographics
NPI:1891885711
Name:MAXSON, DEREK KYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:KYLE
Last Name:MAXSON
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 1:9907 S HIGHWAY 6 STE 360
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-4997
Mailing Address - Country:US
Mailing Address - Phone:832-328-0303
Mailing Address - Fax:832-328-0404
Practice Address - Street 1:9907 S HIGHWAY 6
Practice Address - Street 2:SUITE 360
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-4995
Practice Address - Country:US
Practice Address - Phone:832-328-0303
Practice Address - Fax:832-328-0404
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608318OtherBCBS
TX612980OtherMEDICARE PTAN