Provider Demographics
NPI:1134201619
Name:MASHIKE, ADAM (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:MASHIKE
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 1:851 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2086
Mailing Address - Country:US
Mailing Address - Phone:734-354-0020
Mailing Address - Fax:734-354-0046
Practice Address - Street 1:851 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2086
Practice Address - Country:US
Practice Address - Phone:734-354-0020
Practice Address - Fax:734-354-0046
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL559986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION14470Medicare ID - Type Unspecified