Provider Demographics
NPI:1518245208
Name:NIEMAN, EDWARD HOVEY
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:HOVEY
Last Name:NIEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E WASHINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4120
Mailing Address - Country:US
Mailing Address - Phone:909-433-3200
Mailing Address - Fax:909-424-0910
Practice Address - Street 1:900 E WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4120
Practice Address - Country:US
Practice Address - Phone:909-433-3200
Practice Address - Fax:909-424-0910
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor