Provider Demographics
NPI:1821361163
Name:ZACHMAN, ADAM MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MARK
Last Name:ZACHMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ADAM
Other - Middle Name:MARK
Other - Last Name:ZACHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:104 NE 3RD ST
Mailing Address - Street 2:STE 220
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2869
Mailing Address - Country:US
Mailing Address - Phone:763-670-3379
Mailing Address - Fax:
Practice Address - Street 1:104 NE 3RD ST
Practice Address - Street 2:STE 220
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2869
Practice Address - Country:US
Practice Address - Phone:763-670-3379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350005030OtherPTAN