Provider Demographics
NPI:1467070268
Name:PRESTON, JOHN ADAM (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ADAM
Last Name:PRESTON
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 1:7616 BROCKWAY RD
Mailing Address - Street 2:
Mailing Address - City:BROCKWAY
Mailing Address - State:MI
Mailing Address - Zip Code:48097-3408
Mailing Address - Country:US
Mailing Address - Phone:810-387-3422
Mailing Address - Fax:810-387-3342
Practice Address - Street 1:7616 BROCKWAY RD
Practice Address - Street 2:
Practice Address - City:BROCKWAY
Practice Address - State:MI
Practice Address - Zip Code:48097-3408
Practice Address - Country:US
Practice Address - Phone:810-387-3422
Practice Address - Fax:810-387-3342
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor