Provider Demographics
NPI:1003987801
Name:CHURCH, ADAM R (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:R
Last Name:CHURCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-3032
Mailing Address - Country:US
Mailing Address - Phone:203-466-1111
Mailing Address - Fax:203-468-9684
Practice Address - Street 1:185 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-3032
Practice Address - Country:US
Practice Address - Phone:203-466-1111
Practice Address - Fax:203-468-9684
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001229Medicare UPIN
CT350001229Medicare ID - Type Unspecified