Provider Demographics
NPI:1063678571
Name:PRATT, EDWARD PRESTON (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PRESTON
Last Name:PRATT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 KINZIE AVE.
Mailing Address - Street 2:
Mailing Address - City:LOST NATION
Mailing Address - State:IA
Mailing Address - Zip Code:52254
Mailing Address - Country:US
Mailing Address - Phone:563-678-2568
Mailing Address - Fax:
Practice Address - Street 1:505 KINZIE AVE.
Practice Address - Street 2:
Practice Address - City:LOST NATION
Practice Address - State:IA
Practice Address - Zip Code:52254
Practice Address - Country:US
Practice Address - Phone:563-678-2568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05969111N00000X
NH231-0686A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor