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General NPI Number Information
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NPI Number | 1982909974
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Entity Type | Individual
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Provider Name | ADAM N TICE N.D.
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Gender | Male
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 105 S RIVERSIDE DR STE 131
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City | INDIALANTIC
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State | FL
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Zip | 32903-4321
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Country | US
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Telephone | 321-409-0044
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Fax | 321-409-0099
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Provider Business Mailing Address
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Address Line | 105 S RIVERSIDE DR STE 131
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City | INDIALANTIC
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State | FL
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Zip | 32903-4321
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Country | US
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Telephone | 321-409-0044
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Fax | 321-409-0099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 099.0074285
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License Number State | VT
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