Provider Demographics
NPI:1235168121
Name:FASICK, ADAM RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:RUSSELL
Last Name:FASICK
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 1:3220 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8563
Mailing Address - Country:US
Mailing Address - Phone:517-376-6836
Mailing Address - Fax:517-376-6862
Practice Address - Street 1:3220 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8563
Practice Address - Country:US
Practice Address - Phone:517-376-6836
Practice Address - Fax:517-376-6862
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF008301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI138952OtherPREFERRED CHOICES PPO ID
MI200334885OtherPPOM ID
MI1235168121Medicaid
MI950D710500OtherBCBS ID