Healthcare Provider Details

I. General information

NPI: 1245822758
Provider Name (Legal Business Name): JORDAN MICHAEL MAXWELL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 E MISSOURI AVE STE 402
PHOENIX AZ
85014-2724
US

IV. Provider business mailing address

4218 STEPPING STONE LN
LIVERPOOL NY
13090-1826
US

V. Phone/Fax

Practice location:
  • Phone: 315-391-7949
  • Fax:
Mailing address:
  • Phone: 315-391-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number012285
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007444
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX01371701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: