Provider Demographics
NPI:1851325450
Name:MACK, ADAM P (DC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:P
Last Name:MACK
Suffix:
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 1:8930 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-2318
Mailing Address - Country:US
Mailing Address - Phone:440-740-0696
Mailing Address - Fax:440-740-0697
Practice Address - Street 1:8930 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-2318
Practice Address - Country:US
Practice Address - Phone:440-740-0696
Practice Address - Fax:440-740-0697
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2328814Medicaid
OHU78616Medicare UPIN
OHMA4086901Medicare PIN