Provider Demographics
NPI:1275081424
Name:PRUCHNICKI, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:PRUCHNICKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1708
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48347-1708
Mailing Address - Country:US
Mailing Address - Phone:248-922-9200
Mailing Address - Fax:248-922-9700
Practice Address - Street 1:7508 M E CAD BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4281
Practice Address - Country:US
Practice Address - Phone:248-922-9200
Practice Address - Fax:248-922-9700
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist