Provider Demographics
NPI:1427384098
Name:EDGEWATER REHABILITATION & WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:EDGEWATER REHABILITATION & WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:815-404-3727
Mailing Address - Street 1:7 SHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5929
Mailing Address - Country:US
Mailing Address - Phone:815-404-3727
Mailing Address - Fax:
Practice Address - Street 1:545 N LAKE ST
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1826
Practice Address - Country:US
Practice Address - Phone:815-404-3727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty