Provider Demographics
NPI:1497751218
Name:EDWARDS, JERROD M (DC)
Entity Type:Individual
Prefix:DR
First Name:JERROD
Middle Name:M
Last Name:EDWARDS
Suffix:
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 1:2810 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2310
Mailing Address - Country:US
Mailing Address - Phone:817-467-9233
Mailing Address - Fax:817-468-4777
Practice Address - Street 1:2810 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2310
Practice Address - Country:US
Practice Address - Phone:817-467-9233
Practice Address - Fax:817-468-4777
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D2482Medicare ID - Type Unspecified
TXU90534Medicare UPIN