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General NPI Number Information
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NPI Number | 1841592532
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Entity Type | Organization
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Legal Business Name | DAVID G MADISON DC CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 3768 JURUPA AVENUE
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City | RIVERSIDE
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State | CA
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Zip | 92506
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Country | US
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Telephone | 951-784-7800
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Fax | 951-784-7803
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Provider Business Mailing Address
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Address Line | 3768 JURUPA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2514
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Country | US
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Telephone | 951-784-7800
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Fax | 951-784-7803
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. DAVID GARY MADISON
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Credential | DC
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Telephone | 951-784-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DC11474
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License Number State | CA
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