Provider Demographics
NPI:1912071911
Name:MADDEN, PETER C (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:MADDEN
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:PO BOX 7803
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-0803
Mailing Address - Country:US
Mailing Address - Phone:609-882-7719
Mailing Address - Fax:609-882-7720
Practice Address - Street 1:795 PARKWAY AVE STE A1
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2704
Practice Address - Country:US
Practice Address - Phone:609-882-7719
Practice Address - Fax:609-882-7720
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00560100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU82647Medicare UPIN
NJ043655Medicare ID - Type Unspecified