Provider Demographics
NPI:1639215957
Name:BLENDERMANN, EDWARD LUDWIG (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LUDWIG
Last Name:BLENDERMANN
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 1:1002 SW WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-1864
Mailing Address - Country:US
Mailing Address - Phone:386-299-1981
Mailing Address - Fax:
Practice Address - Street 1:1002 SW WILLOW LN
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-1864
Practice Address - Country:US
Practice Address - Phone:386-299-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 2511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor