Provider Demographics
NPI:1053317727
Name:MADDUX, JOHN JEFFERY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JEFFERY
Last Name:MADDUX
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 1:1121 SW 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3680
Mailing Address - Country:US
Mailing Address - Phone:954-881-3294
Mailing Address - Fax:866-398-0719
Practice Address - Street 1:1121 SW 97TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-3680
Practice Address - Country:US
Practice Address - Phone:954-881-3294
Practice Address - Fax:866-398-0719
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381117400Medicaid
FL55230ZMedicare PIN
U53392Medicare UPIN