Provider Demographics
NPI:1073055851
Name:BREWERS, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BREWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 IRVINE LOOP APT 3103
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-3089
Mailing Address - Country:US
Mailing Address - Phone:507-531-6600
Mailing Address - Fax:
Practice Address - Street 1:137 IRVINE LOOP APT 3103
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-3089
Practice Address - Country:US
Practice Address - Phone:507-531-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND684-152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer