Provider Demographics
NPI:1366412173
Name:WILBURN, ADAM GREGORY (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:GREGORY
Last Name:WILBURN
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 1:379 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2391
Mailing Address - Country:US
Mailing Address - Phone:413-253-2520
Mailing Address - Fax:
Practice Address - Street 1:379 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2391
Practice Address - Country:US
Practice Address - Phone:413-253-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2775111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36984OtherBCBS OF MA
MA2775OtherSTATE LICENSE NUMBER
MAY36984OtherBCBS OF MA
WIY45672Medicare ID - Type Unspecified