Provider Demographics
NPI:1679744650
Name:ADAM CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:ADAM CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:VAL
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-774-5824
Mailing Address - Street 1:200 FAIRBANKS ST
Mailing Address - Street 2:S1
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-1510
Mailing Address - Country:US
Mailing Address - Phone:906-774-5824
Mailing Address - Fax:906-774-6349
Practice Address - Street 1:200 FAIRBANKS ST
Practice Address - Street 2:S1
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-1510
Practice Address - Country:US
Practice Address - Phone:906-774-5824
Practice Address - Fax:906-774-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B210730OtherBLUE SHIELD
MI1071660Medicaid
MI0B25006Medicare PIN