Provider Demographics
NPI:1598731358
Name:MADDOX, CHRISTINE ELLEN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ELLEN
Last Name:MADDOX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 S 76TH ST
Mailing Address - Street 2:16
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4364
Mailing Address - Country:US
Mailing Address - Phone:414-282-9050
Mailing Address - Fax:414-282-9190
Practice Address - Street 1:4811 S 76TH ST
Practice Address - Street 2:SUITE16
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4364
Practice Address - Country:US
Practice Address - Phone:414-282-9050
Practice Address - Fax:414-282-9190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI846046171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor