Provider Demographics
NPI:1497957104
Name:GERALD A MADIR
Entity Type:Organization
Organization Name:GERALD A MADIR
Other - Org Name:AMSDEN WAY CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MADIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-942-5170
Mailing Address - Street 1:9336 ENSIGN AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1455
Mailing Address - Country:US
Mailing Address - Phone:952-942-5170
Mailing Address - Fax:952-942-6295
Practice Address - Street 1:9336 ENSIGN AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1455
Practice Address - Country:US
Practice Address - Phone:952-942-5170
Practice Address - Fax:952-942-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1447261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center