Provider Demographics
NPI:1184655821
Name:DESJARLAIS, EDWARD ALVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALVIN
Last Name:DESJARLAIS
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 1:707 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4108
Mailing Address - Country:US
Mailing Address - Phone:919-776-4304
Mailing Address - Fax:919-776-4305
Practice Address - Street 1:707 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4108
Practice Address - Country:US
Practice Address - Phone:919-776-4304
Practice Address - Fax:919-776-4305
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor