Provider Demographics
NPI:1447488283
Name:MADISON, JAMES (LAC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:MADISON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 6TH ST W
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2903
Mailing Address - Country:US
Mailing Address - Phone:406-270-7467
Mailing Address - Fax:406-863-9469
Practice Address - Street 1:202 6TH ST W
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2903
Practice Address - Country:US
Practice Address - Phone:406-270-7467
Practice Address - Fax:406-863-9469
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT113171100000X
CAAC 5521171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist