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General NPI Number Information
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NPI Number | 1477898104
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Entity Type | Organization
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Legal Business Name | EDWARD A. MADRID, DC, PC
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 09/30/2016
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Provider Practice Location Address
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Address Line | 18631 N 19TH AVE STE 152
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City | PHOENIX
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State | AZ
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Zip | 85027-5800
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Country | US
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Telephone | 602-789-1078
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Fax | 623-582-0997
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Provider Business Mailing Address
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Address Line | 18631 N 19TH AVE STE 152
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City | PHOENIX
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State | AZ
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Zip | 85027-5800
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Country | US
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Telephone | 602-789-1078
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Fax | 623-582-0997
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD MADRID
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Credential | DC
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Telephone | 602-789-1078
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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 | 8560
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License Number State | AZ
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