Provider Demographics
NPI:1275556433
Name:MASSOUD, ADAM C (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:C
Last Name:MASSOUD
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 1:1171 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1426
Mailing Address - Country:US
Mailing Address - Phone:203-637-1111
Mailing Address - Fax:203-637-5956
Practice Address - Street 1:1171 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1426
Practice Address - Country:US
Practice Address - Phone:203-637-1111
Practice Address - Fax:203-637-5956
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor