Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301005983 | MI |
NPI | 1003885328 |
---|---|
Provider Name | Dr. Ronald Keith Adams |
First Address | Jackson, MI 49203-3636 |
Second Address | Jackson, MI 49203-3636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RA005983 | BCBS REFERRING NUMBER (01) | MI |
U37390 | (02) | MI |