Provider Demographics
NPI:1407201015
Name:ADAMS, CONRAD DAVIDSON (LAC, DC)
Entity Type:Individual
Prefix:MR
First Name:CONRAD
Middle Name:DAVIDSON
Last Name:ADAMS
Suffix:
Gender:M
Credentials:LAC, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 NICE DR #101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882
Mailing Address - Country:US
Mailing Address - Phone:310-993-7662
Mailing Address - Fax:951-737-1252
Practice Address - Street 1:2250 S. MAIN ST STE #203
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882
Practice Address - Country:US
Practice Address - Phone:951-737-1252
Practice Address - Fax:951-737-1252
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17009171100000X
CADC36237111N00000X
CAAC17009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor