Provider Demographics
NPI:1053518845
Name:MADOCK, DANIEL JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:MADOCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11404 N 56TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2237
Mailing Address - Country:US
Mailing Address - Phone:813-935-1664
Mailing Address - Fax:813-985-8797
Practice Address - Street 1:11404 N 56TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2237
Practice Address - Country:US
Practice Address - Phone:813-935-1664
Practice Address - Fax:813-985-8797
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH00003299111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380679100Medicaid
FL380679100Medicaid