Provider Demographics
NPI:1902031511
Name:WISCOMB, ADAM REED (LAC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:REED
Last Name:WISCOMB
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:115 SANSOME ST
Mailing Address - Street 2:SUITE 807
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3601
Mailing Address - Country:US
Mailing Address - Phone:415-225-4880
Mailing Address - Fax:415-901-6629
Practice Address - Street 1:115 SANSOME ST
Practice Address - Street 2:SUITE 807
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3601
Practice Address - Country:US
Practice Address - Phone:415-225-4880
Practice Address - Fax:415-901-6629
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11512171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist