MEDICARE: DR. GILBERT M MADRID DC

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	111NX0800X	Orthopedic Chiropractor	15298	CA

General Provider Information

NPI Number	:	1417160888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GILBERT M MADRID DC

Provider Business Mailing Address
First Line	:	1601 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3931
Country	:	US
Telephone Number	:	760-562-4567
Fax Number	:	323-887-1891

Provider Business Practice Location Address
First Line	:	3640 MCKENZIE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-1424
Country	:	US
Telephone Number	:	760-562-4567
Fax Number	:	323-887-1891

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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