Provider Demographics
NPI:1689130957
Name:ADAMS, CHARLES REX
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:REX
Last Name:ADAMS
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 1:2630 PARKWYN DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2011
Mailing Address - Country:US
Mailing Address - Phone:269-615-1486
Mailing Address - Fax:
Practice Address - Street 1:5708 VENTURE CT
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2857
Practice Address - Country:US
Practice Address - Phone:269-353-4833
Practice Address - Fax:269-353-4834
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000184171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist