Healthcare Provider Details

I. General information

NPI: 1316022445
Provider Name (Legal Business Name): MADISON CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W 4TH ST
MADISON MN
56256-1426
US

IV. Provider business mailing address

508 W 4TH ST
MADISON MN
56256-1426
US

V. Phone/Fax

Practice location:
  • Phone: 320-598-3089
  • Fax: 320-598-3211
Mailing address:
  • Phone: 320-598-3089
  • Fax: 320-598-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3882
License Number StateMN

VIII. Authorized Official

Name: DR. CLINTON A BONN
Title or Position: OWNER
Credential: D.C.
Phone: 320-598-3089