Provider Demographics
NPI:1093854879
Name:EDEKER, BRETT LAWTON (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:LAWTON
Last Name:EDEKER
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 1:1425 HAWK PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-6452
Mailing Address - Country:US
Mailing Address - Phone:970-240-2181
Mailing Address - Fax:970-240-2188
Practice Address - Street 1:1425 HAWK PKWY STE 1
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6452
Practice Address - Country:US
Practice Address - Phone:970-240-2181
Practice Address - Fax:970-240-2188
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU78082Medicare UPIN
COC48733Medicare PIN