Provider Demographics
NPI:1578622262
Name:EDELSON, STEVEN GREGG (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GREGG
Last Name:EDELSON
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 1:4250 W BAY TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6608
Mailing Address - Country:US
Mailing Address - Phone:813-831-8321
Mailing Address - Fax:813-831-5143
Practice Address - Street 1:4250 W BAY TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6608
Practice Address - Country:US
Practice Address - Phone:813-831-8321
Practice Address - Fax:813-831-5143
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU72466Medicare UPIN
FL55462ZMedicare PIN