Provider Demographics
NPI:1932629474
Name:SPESARD, ADAM LOWELL
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:LOWELL
Last Name:SPESARD
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 1:508 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IN
Mailing Address - Zip Code:46929-1108
Mailing Address - Country:US
Mailing Address - Phone:765-414-3991
Mailing Address - Fax:
Practice Address - Street 1:701 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IN
Practice Address - Zip Code:46929-1410
Practice Address - Country:US
Practice Address - Phone:765-414-3991
Practice Address - Fax:765-414-3991
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002977A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor