Provider Demographics
NPI:1063559532
Name:MANDZIUK, ADAM RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:RYAN
Last Name:MANDZIUK
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 1:147 CHAMBERLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653
Mailing Address - Country:US
Mailing Address - Phone:404-550-2032
Mailing Address - Fax:
Practice Address - Street 1:53316 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-1821
Practice Address - Country:US
Practice Address - Phone:586-781-0900
Practice Address - Fax:586-781-8450
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor