Provider Demographics
NPI:1114042769
Name:FOGELMAN, ADAM D (DC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:FOGELMAN
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 1:1118 ELFIN FOREST RD W
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1078
Mailing Address - Country:US
Mailing Address - Phone:858-336-5610
Mailing Address - Fax:
Practice Address - Street 1:4403 MANCHESTER AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4939
Practice Address - Country:US
Practice Address - Phone:760-632-9042
Practice Address - Fax:760-632-0574
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor