Provider Demographics
NPI:1275616245
Name:EDLUND, JOSEPH WADE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WADE
Last Name:EDLUND
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 1:1900 DIVISION ST W UNIT 7
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6397
Mailing Address - Country:US
Mailing Address - Phone:218-751-5910
Mailing Address - Fax:218-444-5911
Practice Address - Street 1:1900 DIVISION ST W UNIT 7
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6397
Practice Address - Country:US
Practice Address - Phone:218-751-5910
Practice Address - Fax:218-444-5911
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3K873EDOtherBLUE CROSS/BLUE SHIELD MN
MN616528100Medicaid
MN616528100Medicaid
MN3K873EDOtherBLUE CROSS/BLUE SHIELD MN