Provider Demographics
NPI:1164450029
Name:FLEMING, EDWARD G (D C)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
Last Name:FLEMING
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 FOURTH AVE
Mailing Address - Street 2:P. O. BOX 033786
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4214
Mailing Address - Country:US
Mailing Address - Phone:321-727-2225
Mailing Address - Fax:
Practice Address - Street 1:322 4TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4214
Practice Address - Country:US
Practice Address - Phone:321-727-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88975Medicare ID - Type Unspecified
FLT77357Medicare UPIN