Provider Demographics
NPI:1437149788
Name:EDWARDS, DAVID A (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4558 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2051
Mailing Address - Country:US
Mailing Address - Phone:904-389-0667
Mailing Address - Fax:904-389-5871
Practice Address - Street 1:4558 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2051
Practice Address - Country:US
Practice Address - Phone:904-389-0667
Practice Address - Fax:904-389-5871
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88450Medicare ID - Type Unspecified
FLT88146Medicare UPIN