Provider Demographics
NPI:1598758963
Name:ADAMS, CLYDELL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CLYDELL
Middle Name:
Last Name:ADAMS
Suffix:JR
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 1:1615 PRECINCT LINE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3345
Mailing Address - Country:US
Mailing Address - Phone:817-503-2188
Mailing Address - Fax:817-479-7733
Practice Address - Street 1:1615 PRECINCT LINE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3345
Practice Address - Country:US
Practice Address - Phone:817-503-2188
Practice Address - Fax:817-479-7733
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor