Provider Demographics
NPI:1952451072
Name:ADAMS, DEAN HOWARD (ATC)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:HOWARD
Last Name:ADAMS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9140 TANAGER CIR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-9303
Mailing Address - Country:US
Mailing Address - Phone:763-295-2674
Mailing Address - Fax:
Practice Address - Street 1:101 14TH ST NE # A
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2927
Practice Address - Country:US
Practice Address - Phone:763-684-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer