Provider Demographics
NPI:1639963127
Name:MAXA, CECILEY JEANNE (DC)
Entity type:Individual
Prefix:DR
First Name:CECILEY
Middle Name:JEANNE
Last Name:MAXA
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:CECILEY
Other - Middle Name:JEANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13914 LUPINE TRL NE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2884
Mailing Address - Country:US
Mailing Address - Phone:715-220-8004
Mailing Address - Fax:
Practice Address - Street 1:6001 EGAN DR STE 120
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-4910
Practice Address - Country:US
Practice Address - Phone:952-440-4553
Practice Address - Fax:952-440-4573
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor