Healthcare Provider Details

I. General information

NPI: 1629165527
Provider Name (Legal Business Name): DAVID MADEMANN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7985 US HIGHWAY 9W
CATSKILL NY
12414-5036
US

IV. Provider business mailing address

85 STATE ROUTE 296
WINDHAM NY
12496-5308
US

V. Phone/Fax

Practice location:
  • Phone: 518-943-0633
  • Fax:
Mailing address:
  • Phone: 518-943-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberX08016
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: