Provider Demographics
NPI:1497826788
Name:MADDOX, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MADDOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 N. DALE MABRY HWY.
Mailing Address - Street 2:BLDG 301
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3264
Mailing Address - Country:US
Mailing Address - Phone:813-933-1511
Mailing Address - Fax:813-931-8393
Practice Address - Street 1:8001 N. DALE MABRY HWY.
Practice Address - Street 2:BLDG 301
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3264
Practice Address - Country:US
Practice Address - Phone:813-933-1511
Practice Address - Fax:813-931-8393
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 4089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88852Medicare PIN
FLU21339Medicare UPIN