Healthcare Provider Details

I. General information

NPI: 1952945214
Provider Name (Legal Business Name): MADDEN FAMILY CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 HOTEL CIR S STE 270
SAN DIEGO CA
92108-3414
US

IV. Provider business mailing address

1545 HOTEL CIR S STE 270
SAN DIEGO CA
92108-3414
US

V. Phone/Fax

Practice location:
  • Phone: 619-738-0933
  • Fax:
Mailing address:
  • Phone: 619-738-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY FAVA MADDEN
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 619-738-0933