Provider Demographics
NPI:1457468944
Name:MADDALO, CANDACE MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:MARY
Last Name:MADDALO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:257 CAMBRIDGE ST
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141
Mailing Address - Country:US
Mailing Address - Phone:617-547-4444
Mailing Address - Fax:617-576-2842
Practice Address - Street 1:257 CAMBRIDGE ST
Practice Address - Street 2:SUITE # 1
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1272
Practice Address - Country:US
Practice Address - Phone:617-547-4444
Practice Address - Fax:617-576-4842
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU33725Medicare UPIN
MAY45293Medicare PIN