Provider Demographics
NPI:1629165527
Name:MADEMANN, DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MADEMANN
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 1:85 STATE ROUTE 296
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12496-5308
Mailing Address - Country:US
Mailing Address - Phone:518-943-0633
Mailing Address - Fax:
Practice Address - Street 1:7985 US HIGHWAY 9W
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-5036
Practice Address - Country:US
Practice Address - Phone:518-943-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX08016111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX68692Medicare ID - Type Unspecified