Provider Demographics
NPI:1619070877
Name:EDENS, BRIAN MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:EDENS
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 1:8430 ENTERPRISE CIRCLE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5137
Mailing Address - Country:US
Mailing Address - Phone:941-907-9663
Mailing Address - Fax:941-907-6663
Practice Address - Street 1:8430 ENTERPRISE CIRCLE
Practice Address - Street 2:SUITE 120
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5137
Practice Address - Country:US
Practice Address - Phone:941-907-9663
Practice Address - Fax:941-907-6663
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002413069OtherUNITED HEALTH CARE
FL55950OtherBCBS
FL55950AMedicare ID - Type Unspecified