Healthcare Provider Details

I. General information

NPI: 1982747382
Provider Name (Legal Business Name): ADAM JOHN KERRY ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1569
US

IV. Provider business mailing address

46741 US HIGHWAY 41 APT G
HOUGHTON MI
49931-9046
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1040
  • Fax: 906-483-1043
Mailing address:
  • Phone: 906-869-9971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: