Provider Demographics
NPI:1093799736
Name:ADAM, PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ADAM
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 1:3955 JUNIPER TRL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2083
Mailing Address - Country:US
Mailing Address - Phone:219-923-3083
Mailing Address - Fax:219-923-3083
Practice Address - Street 1:2109 NORTHWINDS DR
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1882
Practice Address - Country:US
Practice Address - Phone:219-864-4311
Practice Address - Fax:219-864-4339
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002201A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000383022OtherANTHEM BLUE SHIELD (CHIRO
IL90001236OtherBLUE SHIELD
IN000000512926OtherANTHEM BLUE SHIELD (ACUPU
IN000000383022OtherANTHEM BLUE SHIELD (CHIRO
IN000000512926OtherANTHEM BLUE SHIELD (ACUPU