Provider Demographics
NPI:1699453167
Name:ADAIR, KENNETH C
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:ADAIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 22 1/2 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:MI
Mailing Address - Zip Code:49245-9446
Mailing Address - Country:US
Mailing Address - Phone:269-967-2176
Mailing Address - Fax:
Practice Address - Street 1:7105 22 1/2 MILE RD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:MI
Practice Address - Zip Code:49245-9446
Practice Address - Country:US
Practice Address - Phone:269-967-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004741225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant