Provider Demographics
NPI:1902573975
Name:MAXWELL DAVIS, TAMARA DESHAUN (DC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:DESHAUN
Last Name:MAXWELL DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13006 SUPERIOR DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1030
Mailing Address - Country:US
Mailing Address - Phone:214-843-4188
Mailing Address - Fax:
Practice Address - Street 1:13612 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-4308
Practice Address - Country:US
Practice Address - Phone:972-661-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty