Provider Demographics
NPI:1619993151
Name:EDEN, TROY (DC)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:
Last Name:EDEN
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 1:1419 11TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1294
Mailing Address - Country:US
Mailing Address - Phone:563-659-9039
Mailing Address - Fax:563-659-3183
Practice Address - Street 1:1419A 11TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1247
Practice Address - Country:US
Practice Address - Phone:563-659-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0243485Medicaid
IA45735OtherBLUE CROSS BLUE SHIELD
IAI10890Medicare ID - Type Unspecified
IA0243485Medicaid