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General NPI Number Information
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NPI Number | 1316022445
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Entity Type | Organization
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Legal Business Name | MADISON CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 508 W 4TH ST
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City | MADISON
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State | MN
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Zip | 56256-1426
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Country | US
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Telephone | 320-598-3089
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Fax | 320-598-3211
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Provider Business Mailing Address
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Address Line | 508 W 4TH ST
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City | MADISON
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State | MN
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Zip | 56256-1426
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Country | US
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Telephone | 320-598-3089
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Fax | 320-598-3211
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLINTON A BONN
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Credential | D.C.
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Telephone | 320-598-3089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3882
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License Number State | MN
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