Provider Demographics
NPI:1235599689
Name:MADIGAN FAMILY LLC
Entity Type:Organization
Organization Name:MADIGAN FAMILY LLC
Other - Org Name:MADIGAN FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MADIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-267-0425
Mailing Address - Street 1:4098 SW BALLETO ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5382
Mailing Address - Country:US
Mailing Address - Phone:772-267-0425
Mailing Address - Fax:
Practice Address - Street 1:4098 SW BALLETO ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5382
Practice Address - Country:US
Practice Address - Phone:772-267-0425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-27
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty