Provider Demographics
NPI:1750503405
Name:MADERO, NICHOLAS P (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:P
Last Name:MADERO
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 1:1949 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3007
Mailing Address - Country:US
Mailing Address - Phone:646-210-3485
Mailing Address - Fax:718-837-6471
Practice Address - Street 1:2273 65TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4086
Practice Address - Country:US
Practice Address - Phone:718-236-4970
Practice Address - Fax:718-236-5274
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009088111NS0005X
FLCH9290111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXAWCB1Medicare ID - Type UnspecifiedGROUP #
U98352Medicare UPIN
NYX6E661Medicare ID - Type UnspecifiedINDIVIDUAL#