Provider Demographics
NPI:1871252940
Name:EDET, LAURA SARA (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:SARA
Last Name:EDET
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 PISCATAWAY RD STE 310
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2566
Mailing Address - Country:US
Mailing Address - Phone:240-244-2818
Mailing Address - Fax:
Practice Address - Street 1:9135 PISCATAWAY RD STE 310
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2566
Practice Address - Country:US
Practice Address - Phone:240-244-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13835111N00000X
VAS04174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty