Provider Demographics
NPI:1851314553
Name:MADORNO, MICHAEL T (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:MADORNO
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 1:9002 LINCOLN DR W STE B
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3204
Mailing Address - Country:US
Mailing Address - Phone:856-985-3336
Mailing Address - Fax:856-985-5615
Practice Address - Street 1:9002 LINCOLN DR W STE B
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3204
Practice Address - Country:US
Practice Address - Phone:856-985-3336
Practice Address - Fax:856-985-5615
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ721558741OtherHORIZON
NJ2147939000OtherAMERIHELATH ID#
NJ3181995OtherAETNA
NJMC05871OtherNJ STATE LICENSE
NJP00030803OtherRAILRAOD MEDICARE
NJ052149Medicare PIN
NJ721558741OtherHORIZON