Provider Demographics
NPI:1528399664
Name:MADEIRA CHIROPRACTIC WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:MADEIRA CHIROPRACTIC WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MADEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-533-6100
Mailing Address - Street 1:158 W CARACAS AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1510
Mailing Address - Country:US
Mailing Address - Phone:717-533-6100
Mailing Address - Fax:717-534-1957
Practice Address - Street 1:158 W CARACAS AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1510
Practice Address - Country:US
Practice Address - Phone:717-533-6100
Practice Address - Fax:717-534-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC2415L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty