Provider Demographics
NPI:1740367408
Name:MADDOX, WARREN ARTHUR JR (DC)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:ARTHUR
Last Name:MADDOX
Suffix:JR
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 1:80 NASHUA RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3426
Mailing Address - Country:US
Mailing Address - Phone:603-437-1700
Mailing Address - Fax:603-437-1565
Practice Address - Street 1:80 NASHUA RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3426
Practice Address - Country:US
Practice Address - Phone:603-437-1700
Practice Address - Fax:603-437-1565
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH116-0459-0183A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH25824Medicare UPIN
NHNH8824Medicare ID - Type Unspecified