Provider Demographics
NPI:1356663371
Name:EDISON CHIROPRACTOR CENTER INC
Entity Type:Organization
Organization Name:EDISON CHIROPRACTOR CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-689-5555
Mailing Address - Street 1:6325 PRESIDENTIAL CT STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3515
Mailing Address - Country:US
Mailing Address - Phone:239-689-5555
Mailing Address - Fax:239-689-5556
Practice Address - Street 1:6325 PRESIDENTIAL CT STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3515
Practice Address - Country:US
Practice Address - Phone:239-689-5555
Practice Address - Fax:239-689-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6817261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy