Provider Demographics
NPI:1922183805
Name:MAXWELL, KIMBERLY ANNETTE (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNETTE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 W KOCH ST
Mailing Address - Street 2:STE A
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4013
Mailing Address - Country:US
Mailing Address - Phone:406-585-7000
Mailing Address - Fax:406-585-7102
Practice Address - Street 1:2245 W KOCH ST
Practice Address - Street 2:STE A
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4013
Practice Address - Country:US
Practice Address - Phone:406-585-7000
Practice Address - Fax:406-585-7102
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000041811OtherBLUE CROSS/BLUE SHIELD
MT0165321Medicaid
MT0165291Medicaid