Provider Demographics
NPI:1518020171
Name:DAILEY, EDWARD JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAMES
Last Name:DAILEY
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:PO BOX 36952
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44735-6952
Mailing Address - Country:US
Mailing Address - Phone:330-498-9445
Mailing Address - Fax:330-498-9447
Practice Address - Street 1:5395 GOVERNORS AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-1473
Practice Address - Country:US
Practice Address - Phone:330-498-9445
Practice Address - Fax:330-498-9447
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1501111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0749971Medicaid
OH0749971Medicaid
OHDA0647414Medicare ID - Type Unspecified