Provider Demographics
NPI:1124561311
Name:MACDONALD, ADAM JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JAMES
Last Name:MACDONALD
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 1:109 FOUR SEASONS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-2646
Mailing Address - Country:US
Mailing Address - Phone:248-770-4930
Mailing Address - Fax:
Practice Address - Street 1:5154 MILLER RD STE J
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1069
Practice Address - Country:US
Practice Address - Phone:810-733-0310
Practice Address - Fax:810-733-5554
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor