Provider Demographics
NPI:1386689289
Name:EDGE, ADAM C (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:C
Last Name:EDGE
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 112
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-0112
Mailing Address - Country:US
Mailing Address - Phone:614-527-1776
Mailing Address - Fax:614-527-1774
Practice Address - Street 1:4961 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1641
Practice Address - Country:US
Practice Address - Phone:614-527-1776
Practice Address - Fax:614-527-1774
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1666111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0818333Medicaid
OH0818333Medicaid