Provider Demographics
NPI:1356474100
Name:ADAMS, SAM (DC)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
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 1:4646 HIGHLAND DR
Mailing Address - Street 2:ST 101
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5135
Mailing Address - Country:US
Mailing Address - Phone:801-277-5665
Mailing Address - Fax:801-277-5666
Practice Address - Street 1:4646 HIGHLAND DR
Practice Address - Street 2:ST 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5135
Practice Address - Country:US
Practice Address - Phone:801-277-5665
Practice Address - Fax:801-277-5666
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363476-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005554601Medicare PIN
005554601Medicare ID - Type Unspecified