Provider Demographics
NPI:1609498468
Name:CHILDS, ADAM MICHAEL
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:CHILDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 REUTER RD
Mailing Address - Street 2:
Mailing Address - City:MAZOMANIE
Mailing Address - State:WI
Mailing Address - Zip Code:53560-9647
Mailing Address - Country:US
Mailing Address - Phone:608-553-0528
Mailing Address - Fax:
Practice Address - Street 1:240 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588-8062
Practice Address - Country:US
Practice Address - Phone:608-588-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program