Provider Demographics
NPI:1467547455
Name:CHEVALIER, EDWARD R JR (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:CHEVALIER
Suffix:JR
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 1:7257 FULTON DR NW
Mailing Address - Street 2:STE 73
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3817
Mailing Address - Country:US
Mailing Address - Phone:330-834-1444
Mailing Address - Fax:330-834-0444
Practice Address - Street 1:7257 FULTON DR NW
Practice Address - Street 2:SUITE 73
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3816
Practice Address - Country:US
Practice Address - Phone:330-834-1444
Practice Address - Fax:330-834-0444
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2091187Medicaid
OH2091187Medicaid
OH4230561Medicare PIN