Provider Demographics
NPI:1346345543
Name:SEDLOCK, ADAM C JR (MS)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:C
Last Name:SEDLOCK
Suffix:JR
Gender:M
Credentials:MS
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 10
Mailing Address - Street 2:
Mailing Address - City:CHALK HILL
Mailing Address - State:PA
Mailing Address - Zip Code:15421-0010
Mailing Address - Country:US
Mailing Address - Phone:724-880-5173
Mailing Address - Fax:
Practice Address - Street 1:136 E FAYETTE ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3625
Practice Address - Country:US
Practice Address - Phone:724-438-2342
Practice Address - Fax:724-438-0766
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005888-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009295090009Medicaid
PA363090OtherBC/BS
PA644833Medicare ID - Type Unspecified