Provider Demographics
NPI:1407062979
Name:CRAVEN, EDNA (DC)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-4453
Mailing Address - Country:US
Mailing Address - Phone:972-256-0004
Mailing Address - Fax:972-659-1699
Practice Address - Street 1:3200 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4453
Practice Address - Country:US
Practice Address - Phone:972-256-0004
Practice Address - Fax:972-659-1699
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6849111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition