Healthcare Provider Details

I. General information

NPI: 1841592532
Provider Name (Legal Business Name): DAVID G MADISON DC CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3768 JURUPA AVENUE
RIVERSIDE CA
92506
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 Code261Q00000X
TaxonomyClinic/Center
License NumberDC11474
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID GARY MADISON
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 951-784-7800