Provider Demographics
NPI:1821877960
Name:REX, MADDISON NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MADDISON
Middle Name:NICOLE
Last Name:REX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:REX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2685 S PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:HARROD
Mailing Address - State:OH
Mailing Address - Zip Code:45850-9765
Mailing Address - Country:US
Mailing Address - Phone:419-296-5747
Mailing Address - Fax:
Practice Address - Street 1:932 N PERRY ST STE A
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1264
Practice Address - Country:US
Practice Address - Phone:419-523-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor