Provider Demographics
NPI:1306006143
Name:ADAMS, OLIXN LEE (DO)
Entity Type:Individual
Prefix:
First Name:OLIXN
Middle Name:LEE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23400 US HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089
Mailing Address - Country:US
Mailing Address - Phone:719-738-4590
Mailing Address - Fax:719-738-4553
Practice Address - Street 1:23400 US HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:WALSENBURG
Practice Address - State:CO
Practice Address - Zip Code:81089
Practice Address - Country:US
Practice Address - Phone:719-738-4590
Practice Address - Fax:719-738-4553
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48070OtherCO LICENSE