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General NPI Number Information
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NPI Number | 1992378905
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Entity Type | Individual
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Provider Name | MADISON CHAMPAGNE
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Gender | Female
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 3101 WASHINGTON ST
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City | MIDLAND
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State | MI
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Zip | 48642-3752
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Country | US
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Telephone | 989-315-1146
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Fax |
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Provider Business Mailing Address
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Address Line | 204 BUFFALO ST
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City | BAD AXE
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State | MI
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Zip | 48413-1405
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Country | US
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Telephone | 989-315-1146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2301011115
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License Number State | MI
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