Provider Demographics
NPI:1548867591
Name:ADAMS, MICHAEL (LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONG BEACH BLVD UNIT 689
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-7029
Mailing Address - Country:US
Mailing Address - Phone:949-302-0744
Mailing Address - Fax:
Practice Address - Street 1:408 WESTMINSTER AVE STE 10
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4238
Practice Address - Country:US
Practice Address - Phone:949-302-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18916261QP3300X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty