Provider Demographics
NPI:1073324109
Name:KISAN, MAXWELL (DC)
Entity type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:
Last Name:KISAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CRESSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-2424
Mailing Address - Country:US
Mailing Address - Phone:412-401-4584
Mailing Address - Fax:
Practice Address - Street 1:3020 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-7158
Practice Address - Country:US
Practice Address - Phone:412-401-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC012012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor