Provider Demographics
NPI:1750491858
Name:EDWARDS, LONNEY DEAN (DC)
Entity Type:Individual
Prefix:MR
First Name:LONNEY
Middle Name:DEAN
Last Name:EDWARDS
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 1:6725 N GOLDEN STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722
Mailing Address - Country:US
Mailing Address - Phone:559-431-2648
Mailing Address - Fax:408-457-7611
Practice Address - Street 1:6725 N GOLDEN STATE BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722
Practice Address - Country:US
Practice Address - Phone:559-431-2648
Practice Address - Fax:408-457-7611
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13506D.C.111N00000X
CA13506 CHIROPRACTIC111N00000X
CA13506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
133506 D.C.Medicare PIN