Provider Demographics
NPI:1124758909
Name:BAUM, MAXWELL RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:RYAN
Last Name:BAUM
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 1:12895 S CONSTANCE ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-5822
Mailing Address - Country:US
Mailing Address - Phone:913-952-0139
Mailing Address - Fax:
Practice Address - Street 1:12895 S CONSTANCE ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-5822
Practice Address - Country:US
Practice Address - Phone:913-952-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2130111N00000X
KS01-06247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor