Provider Demographics
NPI:1295796506
Name:COTTRELL, JOHN ADAM (DC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ADAM
Last Name:COTTRELL
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 1:8600 W STATE ROAD 84 STE C
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4558
Mailing Address - Country:US
Mailing Address - Phone:954-424-1142
Mailing Address - Fax:954-424-1143
Practice Address - Street 1:8600 W STATE ROAD 84 STE C
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4558
Practice Address - Country:US
Practice Address - Phone:954-424-1142
Practice Address - Fax:954-424-1143
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V07555Medicare UPIN
FLU6578AMedicare ID - Type Unspecified