Healthcare Provider Details

I. General information

NPI: 1205891157
Provider Name (Legal Business Name): MADEIRA CHIROPRACTIC AND REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 KENNEBEC DRIVE
CHAMBERSBURG PA
17201
US

IV. Provider business mailing address

1124 KENNEBEC DR
CHAMBERSBURG PA
17201-2809
US

V. Phone/Fax

Practice location:
  • Phone: 717-263-8919
  • Fax: 717-263-2655
Mailing address:
  • Phone: 717-263-8919
  • Fax: 717-263-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALFRED LOUIS MADEIRA
Title or Position: OWNER PRESIDENT
Credential: DC
Phone: 717-263-8919