Provider Demographics
NPI:1588365480
Name:MARQUEZ, MADISON SHEA (DC)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:SHEA
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1750 MCCULLOCH BLVD N UNIT 2432
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-5099
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2240 MCCULLOCH BLVD N STE C
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6904
Practice Address - Country:US
Practice Address - Phone:928-453-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9263111N00000X
CADC36604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor