Healthcare Provider Details

I. General information

NPI: 1386715936
Provider Name (Legal Business Name): WILLIAM FRANK MADOSKY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 BELLEVUE AVE
SAINT LOUIS MO
63117-1704
US

IV. Provider business mailing address

1202 BELLEVUE AVE
SAINT LOUIS MO
63117-1704
US

V. Phone/Fax

Practice location:
  • Phone: 314-644-0885
  • Fax: 314-644-5836
Mailing address:
  • Phone: 314-644-0885
  • Fax: 314-644-5836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCE005492
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: