Provider Demographics
NPI:1962474411
Name:INTRONA, ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:INTRONA
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 1:850 22ND AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241
Mailing Address - Country:US
Mailing Address - Phone:319-358-8999
Mailing Address - Fax:319-834-1128
Practice Address - Street 1:850 22ND AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-358-8999
Practice Address - Fax:319-834-1128
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0196774Medicaid
IA0196774Medicaid
IA04079Medicare ID - Type Unspecified