Provider Demographics
NPI:1982909974
Name:TICE, ADAM N (ND)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:N
Last Name:TICE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S RIVERSIDE DR STE 131
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4321
Mailing Address - Country:US
Mailing Address - Phone:321-409-0044
Mailing Address - Fax:321-409-0099
Practice Address - Street 1:105 S RIVERSIDE DR STE 131
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4321
Practice Address - Country:US
Practice Address - Phone:321-409-0044
Practice Address - Fax:321-409-0099
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0074285175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath