Provider Demographics
NPI:1740595685
Name:FLOYD, EDWIN CARLYLE (MS,DC(DIM))
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:CARLYLE
Last Name:FLOYD
Suffix:
Gender:M
Credentials:MS,DC(DIM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 S BEVERLY DR
Mailing Address - Street 2:536
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3851
Mailing Address - Country:US
Mailing Address - Phone:323-290-6159
Mailing Address - Fax:310-844-7411
Practice Address - Street 1:6820 LA TIJERA BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1908
Practice Address - Country:US
Practice Address - Phone:323-290-6159
Practice Address - Fax:310-844-7411
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11903111NN1001X
ID1740595685174400000X, 175L00000X
CA0004175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No111NN1001XChiropractic ProvidersChiropractorNutrition
No175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740595685OtherSOLE PROVIDER