Provider Demographics
NPI:1790860476
Name:EDENZON, MICHAEL JARED (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JARED
Last Name:EDENZON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15 BURNT MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3947
Mailing Address - Country:US
Mailing Address - Phone:856-422-9234
Mailing Address - Fax:856-422-9233
Practice Address - Street 1:1010 CONCORD AVENUE
Practice Address - Street 2:STE 101
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-3366
Practice Address - Country:US
Practice Address - Phone:302-777-5551
Practice Address - Fax:302-777-5567
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007149-L111NN1001X
DE111NN1001X111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition