Provider Demographics
NPI:1235646993
Name:EDWARDS, WILLIAM RANDOLPH JO (DC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RANDOLPH JO
Last Name:EDWARDS
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 1:8267 E MERRYWEATHER LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2317
Mailing Address - Country:US
Mailing Address - Phone:714-353-2773
Mailing Address - Fax:866-627-8003
Practice Address - Street 1:8267 E MERRYWEATHER LN
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2317
Practice Address - Country:US
Practice Address - Phone:714-353-2773
Practice Address - Fax:866-627-8003
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty