Provider Demographics
NPI:1487619557
Name:KLOTZEK, ADAM STANLEY (DC, DACNB)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:STANLEY
Last Name:KLOTZEK
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2620
Mailing Address - Country:US
Mailing Address - Phone:612-374-3392
Mailing Address - Fax:612-374-3477
Practice Address - Street 1:1311 W 25TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2620
Practice Address - Country:US
Practice Address - Phone:612-374-3392
Practice Address - Fax:612-374-3477
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCH2685111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2685Medicaid
SCU58987Medicare ID - Type UnspecifiedGROUP #7897