Provider Demographics
NPI:1477623304
Name:ADAMS, JERSEY III (LAC)
Entity Type:Individual
Prefix:MR
First Name:JERSEY
Middle Name:
Last Name:ADAMS
Suffix:III
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14411 SAN CRISTOBAL DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4321
Mailing Address - Country:US
Mailing Address - Phone:562-547-8304
Mailing Address - Fax:
Practice Address - Street 1:9723 ALONDRA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3603
Practice Address - Country:US
Practice Address - Phone:562-894-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9045171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist