Andra E. Maddox, LMT
Individual provider Active NPI Specialist · El Prado, NM
NPI 1548045941 · NPPES record last updated Aug 25, 2023
Key facts
- NPI
- 1548045941
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- MT8027 (NM)
- Practice address
- 98 State Highway 150
Suite 7
El Prado, NM 87529-1589 - Phone
- (575) 776-1117
- Fax
- (575) 776-1119
- NPI assigned
- Aug 25, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT8027 | NM | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Colonias Chiropractic Center Inc | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MT8027 | NM | Yes |
Addresses
Primary practice location
98 State Highway 150
Suite 7
El Prado, NM 87529-1589
Mailing address
PO Box 1589
El Prado, NM 87529-1589
Phone (575) 776-1117
Other providers in El Prado, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.