=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366831257
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAXIMILIAN BICOFF DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2015
-----------------------------------------------------
Last Update Date | 07/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1121 SE DOCK ST
-----------------------------------------------------
City | OAK HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98277-4067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-675-1066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32650 SR 20STE D101
-----------------------------------------------------
City | OAK HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-229-7232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH60517754
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------