Provider Demographics
NPI:1104880889
Name:MADEIRA, ALFRED LOUIS (DC)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:LOUIS
Last Name:MADEIRA
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 1:1124 KENNEBEC DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201
Mailing Address - Country:US
Mailing Address - Phone:717-263-8919
Mailing Address - Fax:717-263-2655
Practice Address - Street 1:1124 KENNEBEC DRIVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-263-8919
Practice Address - Fax:717-263-2655
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002849L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02728100OtherCAPITAL BC
PA452467OtherHIGHMARK BS
T30512Medicare UPIN
452467Medicare ID - Type Unspecified