Provider Demographics
NPI:1841592532
Name:DAVID G MADISON DC CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:DAVID G MADISON DC CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-784-7800
Mailing Address - Street 1:3768 JURUPA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2514
Mailing Address - Country:US
Mailing Address - Phone:951-784-7800
Mailing Address - Fax:951-784-7803
Practice Address - Street 1:3768 JURUPA AVENUE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506
Practice Address - Country:US
Practice Address - Phone:951-784-7800
Practice Address - Fax:951-784-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11474261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0114740OtherMEDICARE PTAN
CAT04357Medicare UPIN