Provider Demographics
NPI:1508873803
Name:MADISON, DAVID G (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:MADISON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3768 JURUPA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2514
Mailing Address - Country:US
Mailing Address - Phone:951-784-7800
Mailing Address - Fax:951-784-7803
Practice Address - Street 1:3768 JURUPA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2514
Practice Address - Country:US
Practice Address - Phone:951-784-7800
Practice Address - Fax:951-784-7803
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11474111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic