Provider Demographics
NPI:1245822758
Name:MAXWELL, JORDAN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MICHAEL
Last Name:MAXWELL
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 1:4218 STEPPING STONE LN
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1826
Mailing Address - Country:US
Mailing Address - Phone:315-391-7949
Mailing Address - Fax:
Practice Address - Street 1:215 1ST ST
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5110
Practice Address - Country:US
Practice Address - Phone:315-680-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX01371701111N00000X
NY007444171100000X
CADC36021111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist