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General NPI Number Information
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NPI Number | 1760336358
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Entity Type | Organization
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Legal Business Name | MADISON GOLF PERFORMANCE, LLC
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 555 S MIDVALE BLVD STE 113
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City | MADISON
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State | WI
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Zip | 53711-1419
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Country | US
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Telephone | 608-292-4466
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Fax | 608-544-8146
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Provider Business Mailing Address
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Address Line | 555 S MIDVALE BLVD STE 113
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City | MADISON
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State | WI
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Zip | 53711-1419
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Country | US
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Telephone | 608-292-4466
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Fax | 608-544-8146
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | MICHAEL BLODGETT
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Credential | DC
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Telephone | 920-427-2894
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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 |
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License Number State |
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