Provider Demographics
NPI:1851489413
Name:ADAMS, JEREMY TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:TODD
Last Name:ADAMS
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 1:1829 ELIZA DOSTER RD NW
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-3607
Mailing Address - Country:US
Mailing Address - Phone:678-313-9273
Mailing Address - Fax:770-207-0753
Practice Address - Street 1:2070 HIGHWAY 11 NW
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30656-4682
Practice Address - Country:US
Practice Address - Phone:770-267-3277
Practice Address - Fax:770-207-0753
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU93585Medicare UPIN
GA35ZCHKHMedicare ID - Type Unspecified