Provider Demographics
NPI:1316092711
Name:MAXWELL, DUKE D (DC)
Entity type:Individual
Prefix:DR
First Name:DUKE
Middle Name:D
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DUKE
Other - Middle Name:D
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:510 HACIENDA DR STE 107
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6639
Mailing Address - Country:US
Mailing Address - Phone:760-630-8060
Mailing Address - Fax:760-630-7715
Practice Address - Street 1:510 HACIENDA DR
Practice Address - Street 2:SUITE 107
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6637
Practice Address - Country:US
Practice Address - Phone:760-630-8060
Practice Address - Fax:760-630-7715
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22407Medicare ID - Type Unspecified