Provider Demographics
NPI:1063526358
Name:ADAMS, BRUCE GLENN (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:GLENN
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 FRANKFORD AVE STE 2
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1221
Mailing Address - Country:US
Mailing Address - Phone:806-698-0102
Mailing Address - Fax:806-698-0584
Practice Address - Street 1:6302 FRANKFORD
Practice Address - Street 2:SUITE 2
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424
Practice Address - Country:US
Practice Address - Phone:806-698-0102
Practice Address - Fax:806-698-0584
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83490XOtherBLUE CROSS BLUE SHIELD
TX8111877OtherBLUE LINK
TX001237901Medicaid
TX001237901Medicaid
TX8F22650Medicare PIN
TXT11877Medicare UPIN