Provider Demographics
NPI:1962775163
Name:MADDEN, ASHLEY FAVA (DC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:FAVA
Last Name:MADDEN
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 1:3900 FIFTH AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3121
Mailing Address - Country:US
Mailing Address - Phone:619-299-9722
Mailing Address - Fax:619-299-9713
Practice Address - Street 1:3900 FIFTH AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3121
Practice Address - Country:US
Practice Address - Phone:619-299-9722
Practice Address - Fax:619-299-9713
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor