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
State | License ID | Taxonomies |
---|---|---|
IN | 08002201A | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 000000383022 | Other | ANTHEM BLUE SHIELD (CHIRO |
IL | 90001236 | Other | BLUE SHIELD |
IN | 000000512926 | Other | ANTHEM BLUE SHIELD (ACUPU |
IN | 000000383022 | Other | ANTHEM BLUE SHIELD (CHIRO |
IN | 000000512926 | Other | ANTHEM BLUE SHIELD (ACUPU |