Provider Demographics
NPI:1689077745
Name:MADDOX CHIROPRACTIC
Entity Type:Organization
Organization Name:MADDOX CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:603-437-1700
Mailing Address - Street 1:25 NASHUA RD UNIT A5
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3445
Mailing Address - Country:US
Mailing Address - Phone:603-437-1700
Mailing Address - Fax:603-437-1565
Practice Address - Street 1:25 NASHUA RD UNIT A5
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3445
Practice Address - Country:US
Practice Address - Phone:603-437-1700
Practice Address - Fax:603-437-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH116-0459-0183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH25824NHMedicare UPIN
NHNH8824Medicare PIN