Provider Demographics
NPI:1174539647
Name:SYNSVOLL, MAXWELL E (DC)
Entity type:Individual
Prefix:
First Name:MAXWELL
Middle Name:E
Last Name:SYNSVOLL
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 1:1808 SW 9TH AVE. SUITE 110
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9141
Mailing Address - Country:US
Mailing Address - Phone:360-687-6307
Mailing Address - Fax:360-687-6309
Practice Address - Street 1:1808 SW 9TH AVE
Practice Address - Street 2:SUITE110
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-3284
Practice Address - Country:US
Practice Address - Phone:360-687-6307
Practice Address - Fax:360-687-6309
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB19938Medicare ID - Type Unspecified