Provider Demographics
NPI:1326153792
Name:GILARDI, EDMOND E (DC)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:E
Last Name:GILARDI
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:PO BOX 16911
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-6911
Mailing Address - Country:US
Mailing Address - Phone:818-832-9800
Mailing Address - Fax:
Practice Address - Street 1:18419 NORDHOFF ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-2204
Practice Address - Country:US
Practice Address - Phone:818-832-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEG1048712OtherAMERICAN SPECIALTY HEALTH
CADC0280710OtherBLUE SHIELD OF CALIFORNIA
CA675735OtherACN GROUP