Provider Demographics
NPI:1194064162
Name:CANTON, MAXENE (DC)
Entity type:Individual
Prefix:DR
First Name:MAXENE
Middle Name:
Last Name:CANTON
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 1:8686 ANGEL LN
Mailing Address - Street 2:APT 104
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2634
Mailing Address - Country:US
Mailing Address - Phone:302-715-5035
Mailing Address - Fax:302-715-5146
Practice Address - Street 1:911 S DUPONT HWY UNIT 2
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4468
Practice Address - Country:US
Practice Address - Phone:302-715-5035
Practice Address - Fax:302-715-5146
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor