Provider Demographics
NPI:1447470752
Name:ATMAN, ADAM K (LAC MMQ CMT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:K
Last Name:ATMAN
Suffix:
Gender:M
Credentials:LAC MMQ CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 TOSCA TERRACE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:408-476-9799
Mailing Address - Fax:
Practice Address - Street 1:1 W CAMPBELL AVE STE J70
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1040
Practice Address - Country:US
Practice Address - Phone:408-476-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4281171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist