MEDICARE: DR. JOHN JEFFERY MADDUX D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH6456	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053317727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN JEFFERY MADDUX D.C.

Provider Business Mailing Address
First Line	:	1121 SW 97TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-3680
Country	:	US
Telephone Number	:	954-881-3294
Fax Number	:	866-398-0719

Provider Business Practice Location Address
First Line	:	1121 SW 97TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-3680
Country	:	US
Telephone Number	:	954-881-3294
Fax Number	:	866-398-0719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	12/29/2011

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