Provider Demographics
NPI:1417160888
Name:MADRID, GILBERT M (DC)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:M
Last Name:MADRID
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 1:1601 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3931
Mailing Address - Country:US
Mailing Address - Phone:760-562-4567
Mailing Address - Fax:323-887-1891
Practice Address - Street 1:3640 MCKENZIE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1424
Practice Address - Country:US
Practice Address - Phone:760-562-4567
Practice Address - Fax:323-887-1891
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15298111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic