Provider Demographics
NPI:1033419833
Name:PERRY, MADALYN JESSICA (DC)
Entity Type:Individual
Prefix:DR
First Name:MADALYN
Middle Name:JESSICA
Last Name:PERRY
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 1:11430 W BLUEMOUND RD
Mailing Address - Street 2:STE 109
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4050
Mailing Address - Country:US
Mailing Address - Phone:262-422-7457
Mailing Address - Fax:
Practice Address - Street 1:11430 W BLUEMOUND RD
Practice Address - Street 2:STE 109
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4050
Practice Address - Country:US
Practice Address - Phone:262-422-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4641-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor