Provider Demographics
NPI:1053322982
Name:EDWARDS, GARY FORREST (DC, DABCO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:FORREST
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-2053
Mailing Address - Country:US
Mailing Address - Phone:205-989-4114
Mailing Address - Fax:205-989-7149
Practice Address - Street 1:5209 PRINCETON WAY
Practice Address - Street 2:SUITE 601
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-4182
Practice Address - Country:US
Practice Address - Phone:205-989-4114
Practice Address - Fax:205-989-7149
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1131111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-01421OtherBCBS
AL510-01421OtherBCBS
ALT73795Medicare UPIN