Provider Demographics
NPI:1821121732
Name:EDRICH, STEWART JEFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:JEFFREY
Last Name:EDRICH
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 1:3968 CERRITOS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2454
Mailing Address - Country:US
Mailing Address - Phone:562-799-0320
Mailing Address - Fax:
Practice Address - Street 1:3968 CERRITOS AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2454
Practice Address - Country:US
Practice Address - Phone:562-799-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21954111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition