MEDICARE: CROSS WAVES FAMILY CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1124993803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSS WAVES FAMILY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2000 CHENEY HWY STE 103
Second Line	:	BOX #136
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-6028
Country	:	US
Telephone Number	:	321-209-3220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 CHENEY HWY STE 103
Second Line	:	BOX #136
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-6028
Country	:	US
Telephone Number	:	321-209-3220
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. MADALYN MCDANAL
Credential	:	DC
Telephone Number	:	321-209-3220

Provider Enumeration Date	:	10/10/2025
Last Update Date	:	10/10/2025

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