Provider Demographics
NPI:1033389762
Name:TRAYLOR, ADAM GREGORY (DC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:GREGORY
Last Name:TRAYLOR
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:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IN
Mailing Address - Zip Code:47558-0264
Mailing Address - Country:US
Mailing Address - Phone:812-486-2577
Mailing Address - Fax:
Practice Address - Street 1:439 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IN
Practice Address - Zip Code:47558-4501
Practice Address - Country:US
Practice Address - Phone:812-486-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002380A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor