Provider Demographics
NPI:1508193657
Name:MADISON SPINE AND WELLNESS
Entity Type:Organization
Organization Name:MADISON SPINE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BUFFIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-467-0302
Mailing Address - Street 1:1919 VETERANS BOULEVARD SUITE 200
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:802 W BROADWAY STE 104
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-1866
Practice Address - Country:US
Practice Address - Phone:608-224-1419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty