Provider Demographics
NPI:1508017328
Name:KIEFFER, ADAM J (PHD, RD, CSSD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:J
Last Name:KIEFFER
Suffix:
Gender:M
Credentials:PHD, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BAMC - 3851 ROGER BROOKE DRIVE
Mailing Address - Street 2:MCHE-QD (CREDS)
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6200
Mailing Address - Country:US
Mailing Address - Phone:210-916-0254
Mailing Address - Fax:
Practice Address - Street 1:BAMC - 3851 ROGER BROOKE DRIVE
Practice Address - Street 2:NUTRITION CARE DIVISION
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-916-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81407133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered