Provider Demographics
NPI:1497833461
Name:FOGG, ADAM MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MICHAEL
Last Name:FOGG
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 1:314 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-3313
Mailing Address - Country:US
Mailing Address - Phone:616-399-2255
Mailing Address - Fax:616-399-2256
Practice Address - Street 1:314 120TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-3313
Practice Address - Country:US
Practice Address - Phone:616-399-2255
Practice Address - Fax:616-399-2256
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor