Provider Demographics
NPI:1376543181
Name:MADNICK, JONATHAN ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALAN
Last Name:MADNICK
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 1:573 PHILIP RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2937
Mailing Address - Country:US
Mailing Address - Phone:215-938-1507
Mailing Address - Fax:215-639-4588
Practice Address - Street 1:2618 STREET RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2602
Practice Address - Country:US
Practice Address - Phone:215-639-5525
Practice Address - Fax:215-639-4588
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004458L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA618976Medicare ID - Type Unspecified
PAU01840Medicare UPIN