Provider Demographics
NPI:1134460439
Name:POWELL, ADAM L (DO)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:L
Last Name:POWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2680 LEONARD ST NE STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6902
Mailing Address - Country:US
Mailing Address - Phone:616-317-7246
Mailing Address - Fax:
Practice Address - Street 1:2680 LEONARD ST NE STE 3
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6902
Practice Address - Country:US
Practice Address - Phone:616-317-7246
Practice Address - Fax:616-920-6540
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI51010204462081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine