Provider Demographics
NPI:1124672100
Name:GANANN, MADDISON (DC)
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:
Last Name:GANANN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 CANTRELL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4698
Mailing Address - Country:US
Mailing Address - Phone:501-367-5184
Mailing Address - Fax:501-367-5186
Practice Address - Street 1:14300 CANTRELL RD STE 110
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4698
Practice Address - Country:US
Practice Address - Phone:501-367-5184
Practice Address - Fax:501-367-5186
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor