Provider Demographics
NPI:1376536144
Name:EDISON, CHAD WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:WILLIAM
Last Name:EDISON
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 1:1921 W. US 223
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221
Mailing Address - Country:US
Mailing Address - Phone:517-263-2900
Mailing Address - Fax:517-263-9250
Practice Address - Street 1:1921 W. US 223
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221
Practice Address - Country:US
Practice Address - Phone:517-263-2900
Practice Address - Fax:517-263-9250
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICE007123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION29910OtherMEDICARE ID
MIU57944Medicare UPIN