Provider Demographics
NPI:1790726271
Name:EDSON, STEVEN AUGUST (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:AUGUST
Last Name:EDSON
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 1:750 E SAMPLE RD
Mailing Address - Street 2:BLDG 1 UNIT 5
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-5144
Mailing Address - Country:US
Mailing Address - Phone:954-661-8602
Mailing Address - Fax:954-783-1080
Practice Address - Street 1:750 E SAMPLE RD
Practice Address - Street 2:BLDG 1 UNIT 5
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5144
Practice Address - Country:US
Practice Address - Phone:954-661-8602
Practice Address - Fax:954-783-1080
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU97874Medicare UPIN