Individual provider Active NPI

Edward A Madrid, DC

  • Chiropractor
  • Phoenix, AZ
National Provider Identifier
1043385479
Registry record updated Sep 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
8560 Issued in AZ
Practice address
18631 N 19TH Ave
Suite 152
Phoenix, AZ 85027-5299
Phone
(602) 789-1078
Fax
(623) 582-0997
NPI assigned
Nov 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 8560 AZ Primary

Addresses

Primary practice location

18631 N 19TH Ave
Suite 152
Phoenix, AZ 85027-5299

Mailing address

18631 N 19TH Ave
Suite 152
Phoenix, AZ 85027-5299
Phone (602) 789-1078

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161129001028 AZ Practitioner - Chiropractic 6507811957 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8560AZMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Edward a. Madrid, DC, PC Chiropractor Current Accepting new patients
Heart Mountain Chiropractic Chiropractor PastSince Jun 16, 2009 Accepting new patients
Bronson Chiropractic Clinic P.C. Chiropractor PastSince Oct 1, 2016 Accepting new patients
Heart Mountain Chiropractic Inc Chiropractor PastSince Jan 1, 2005 Accepting new patients

Locations

104 E 1st St
Laurel, MT 59044
Phone (406) 628-4622

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475107200000",
    "number": "1043385479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18631 N 19TH AVE",
            "address_2": "SUITE 152",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850275299",
            "telephone_number": "602-789-1078",
            "fax_number": "623-582-0997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18631 N 19TH AVE",
            "address_2": "SUITE 152",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850275299",
            "telephone_number": "602-789-1078",
            "fax_number": "623-582-0997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADRID",
        "first_name": "EDWARD",
        "middle_name": "A",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2016-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "8560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.