Healthcare Provider Details

I. General information

NPI: 1164550414
Provider Name (Legal Business Name): DAPHNE MAXWELL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 S WEBER RD STE D
BOLINGBROOK IL
60490-5488
US

IV. Provider business mailing address

2625 BUTTERFIELD RD STE 301N
OAK BROOK IL
60523-1234
US

V. Phone/Fax

Practice location:
  • Phone: 630-771-9496
  • Fax: 630-771-0361
Mailing address:
  • Phone: 630-320-6400
  • Fax: 630-701-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3347
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011974
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: