Provider Demographics
NPI:1407567613
Name:ARAUZ, EDISON (SC)
Entity Type:Individual
Prefix:
First Name:EDISON
Middle Name:
Last Name:ARAUZ
Suffix:
Gender:M
Credentials:SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 43RD ST S STE 200
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7500
Mailing Address - Country:US
Mailing Address - Phone:701-356-0016
Mailing Address - Fax:701-892-7064
Practice Address - Street 1:1402 43RD ST S STE 200
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7500
Practice Address - Country:US
Practice Address - Phone:701-356-0016
Practice Address - Fax:701-892-7064
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor