Provider Demographics
NPI:1629232111
Name:EDWARDS, JOSEPH VERNON (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VERNON
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 SEQUOIA RD NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1284
Mailing Address - Country:US
Mailing Address - Phone:505-836-3771
Mailing Address - Fax:505-836-5282
Practice Address - Street 1:5300 SEQUOIA RD NW
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1284
Practice Address - Country:US
Practice Address - Phone:505-836-3771
Practice Address - Fax:505-836-5282
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor