Provider Demographics
NPI:1780133397
Name:ADAMS, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 BERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62952-2222
Mailing Address - Country:US
Mailing Address - Phone:618-614-2946
Mailing Address - Fax:
Practice Address - Street 1:308 WILLARDS FERRY RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:IL
Practice Address - Zip Code:62952-1113
Practice Address - Country:US
Practice Address - Phone:618-614-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications