Provider Demographics
NPI:1639200470
Name:MAXWELL, GEORGE JR (DC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MAXWELL
Suffix:JR
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 1:12195 SW ALLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4720
Mailing Address - Country:US
Mailing Address - Phone:503-646-0697
Mailing Address - Fax:503-646-0698
Practice Address - Street 1:12195 SW ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4720
Practice Address - Country:US
Practice Address - Phone:503-646-0697
Practice Address - Fax:503-646-0698
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor