Healthcare Provider Details

I. General information

NPI: 1003746041
Provider Name (Legal Business Name): JOHN DYLAN MAXIE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PROGRESS DR STE 400
MOUNT VERNON KY
40456-8590
US

IV. Provider business mailing address

1420 HUSTONVILLE RD
DANVILLE KY
40422-2424
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-5562
  • Fax: 859-236-5564
Mailing address:
  • Phone: 859-236-5562
  • Fax: 859-236-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number299058
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: