Provider Demographics
NPI:1891784583
Name:CORDERO, EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:CORDERO
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 1:3208 LANTANA RD
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2432
Mailing Address - Country:US
Mailing Address - Phone:561-533-3884
Mailing Address - Fax:561-439-7348
Practice Address - Street 1:3208 LANTANA RD
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-2432
Practice Address - Country:US
Practice Address - Phone:561-533-3884
Practice Address - Fax:561-439-7348
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH006930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380743600Medicaid
FL380743600Medicaid
FL55227Medicare ID - Type UnspecifiedFL MEDICARE