Provider Demographics
NPI:1326122615
Name:NOA, EDWARD JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:NOA
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 1:1371 OLIVER RD # B
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3470
Mailing Address - Country:US
Mailing Address - Phone:707-426-6135
Mailing Address - Fax:707-426-6137
Practice Address - Street 1:1371 OLIVER RD # B
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3470
Practice Address - Country:US
Practice Address - Phone:707-426-6135
Practice Address - Fax:707-426-6137
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16781111NI0900X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NI0900XChiropractic ProvidersChiropractorInternist
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0167810Medicare ID - Type Unspecified
CAT06266Medicare UPIN