Provider Demographics
NPI:1740222710
Name:EDELSON, RENNY M (DC)
Entity Type:Individual
Prefix:DR
First Name:RENNY
Middle Name:M
Last Name:EDELSON
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 1:7668 S.W. 60TH AVENUE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6404
Mailing Address - Country:US
Mailing Address - Phone:352-351-2872
Mailing Address - Fax:352-351-0003
Practice Address - Street 1:7668 S.W. 60TH AVENUE
Practice Address - Street 2:SUITE 500
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6404
Practice Address - Country:US
Practice Address - Phone:352-351-2872
Practice Address - Fax:352-351-0003
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70832OtherBCBS
FL381072100Medicaid
FL381072100Medicaid