Healthcare Provider Details

I. General information

NPI: 1215062757
Provider Name (Legal Business Name): DOUGLAS PAUL MAXEINER D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5791 ZARLEY ST STE B
NEW ALBANY OH
43054-7091
US

IV. Provider business mailing address

7259 TALANTH PL
NEW ALBANY OH
43054-7001
US

V. Phone/Fax

Practice location:
  • Phone: 614-600-2225
  • Fax:
Mailing address:
  • Phone: 614-660-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2008006556
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4266
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: