Healthcare Provider Details

I. General information

NPI: 1982983607
Provider Name (Legal Business Name): MICHAEL WILLIAM MADDEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6790 AMBERLY ST
SAN DIEGO CA
92120-2110
US

IV. Provider business mailing address

6790 AMBERLY ST
SAN DIEGO CA
92120-2110
US

V. Phone/Fax

Practice location:
  • Phone: 619-417-8411
  • Fax: 619-265-1469
Mailing address:
  • Phone: 619-417-8411
  • Fax: 619-265-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: