Provider Demographics
NPI:1619202587
Name:TAMMY S. EDINGTON
Entity Type:Organization
Organization Name:TAMMY S. EDINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:EDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-625-0577
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MI
Mailing Address - Zip Code:48872-0275
Mailing Address - Country:US
Mailing Address - Phone:517-625-0577
Mailing Address - Fax:517-625-0578
Practice Address - Street 1:245 N MAIN
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-9700
Practice Address - Country:US
Practice Address - Phone:517-625-0577
Practice Address - Fax:517-625-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-12
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU863-12Medicare UPIN