Provider Demographics
NPI:1689040180
Name:MADISON, CORY DEAN
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:DEAN
Last Name:MADISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 SCHEURING RD STE A
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-1073
Mailing Address - Country:US
Mailing Address - Phone:920-336-3353
Mailing Address - Fax:920-336-3108
Practice Address - Street 1:1251 SCHEURING RD STE A
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1003
Practice Address - Country:US
Practice Address - Phone:920-336-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5112-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI1089Medicare UPIN