Healthcare Provider Details

I. General information

NPI: 1508873803
Provider Name (Legal Business Name): DAVID G MADISON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3768 JURUPA AVE
RIVERSIDE CA
92506-2514
US

IV. Provider business mailing address

3768 JURUPA AVE
RIVERSIDE CA
92506-2514
US

V. Phone/Fax

Practice location:
  • Phone: 951-784-7800
  • Fax: 951-784-7803
Mailing address:
  • Phone: 951-784-7800
  • Fax: 951-784-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC11474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: