Provider Demographics
NPI:1477898104
Name:EDWARD A. MADRID, DC, PC
Entity Type:Organization
Organization Name:EDWARD A. MADRID, DC, PC
Other - Org Name:BRONSON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-789-1078
Mailing Address - Street 1:18631 N 19TH AVE STE 152
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5800
Mailing Address - Country:US
Mailing Address - Phone:602-789-1078
Mailing Address - Fax:623-582-0997
Practice Address - Street 1:18631 N 19TH AVE STE 152
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5800
Practice Address - Country:US
Practice Address - Phone:602-789-1078
Practice Address - Fax:623-582-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty