Provider Demographics
NPI:1205290509
Name:HAMED MADANI DC PC
Entity type:Organization
Organization Name:HAMED MADANI DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:HAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MADANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-762-1777
Mailing Address - Street 1:598 E 13TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4783
Mailing Address - Country:US
Mailing Address - Phone:541-762-1777
Mailing Address - Fax:541-762-1776
Practice Address - Street 1:598 E 13TH AVE STE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4783
Practice Address - Country:US
Practice Address - Phone:541-762-1777
Practice Address - Fax:541-762-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500628358Medicaid