Provider Demographics
NPI:1295913465
Name:DANIEL J MADOCK DC PA
Entity type:Organization
Organization Name:DANIEL J MADOCK DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MADOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-935-1664
Mailing Address - Street 1:11406 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2237
Mailing Address - Country:US
Mailing Address - Phone:813-935-1664
Mailing Address - Fax:813-985-8797
Practice Address - Street 1:11406 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-2237
Practice Address - Country:US
Practice Address - Phone:813-935-1664
Practice Address - Fax:813-985-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-09
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380679100Medicaid
FL380679100Medicaid