Provider Demographics
NPI:1760806863
Name:SHADICK, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:SHADICK
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 1:9325 UPLAND LN N STE 230
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4450
Mailing Address - Country:US
Mailing Address - Phone:763-315-0466
Mailing Address - Fax:763-315-0884
Practice Address - Street 1:9325 UPLAND LN N STE 230
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4450
Practice Address - Country:US
Practice Address - Phone:763-315-0466
Practice Address - Fax:763-315-0884
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor