Provider Demographics
NPI:1720751944
Name:LISTER, MAXWELL SEAN (DC)
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:SEAN
Last Name:LISTER
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 1:343 W WOLF POINT PLZ UNIT 1911
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-0189
Mailing Address - Country:US
Mailing Address - Phone:217-741-5322
Mailing Address - Fax:
Practice Address - Street 1:16 N PEORIA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2609
Practice Address - Country:US
Practice Address - Phone:217-741-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor