Provider Demographics
NPI:1235311879
Name:ADAMS, PETER M (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:ADAMS
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 1:12276 SAN JOSE BLVD.
Mailing Address - Street 2:SUITE 512
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8618
Mailing Address - Country:US
Mailing Address - Phone:904-880-0202
Mailing Address - Fax:904-880-0822
Practice Address - Street 1:12276 SAN JOSE BLVD.
Practice Address - Street 2:SUITE 512
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8618
Practice Address - Country:US
Practice Address - Phone:904-880-0202
Practice Address - Fax:904-880-0822
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor