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General NPI Number Information
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NPI Number | 1083067375
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Entity Type | Organization
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Legal Business Name | MAXIMUM WELLNESS CHIROPRACTIC
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 14500 RANCH ROAD 12 STE 4
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City | WIMBERLEY
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State | TX
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Zip | 78676-6218
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Country | US
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Telephone | 512-270-8057
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Fax |
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Provider Business Mailing Address
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Address Line | 4701 MONTEREY OAKS BLVD APT 914
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City | AUSTIN
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State | TX
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Zip | 78749-0905
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Country | US
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Telephone | 512-270-8057
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | WILLIAM ANTHONY MAXWELL
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Credential | D.C.
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Telephone | 512-270-8057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 12002
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License Number State | TX
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