Provider Demographics
NPI:1972781532
Name:EDWARDS CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:EDWARDS CHIROPRACTIC CLINIC
Other - Org Name:CROWNE CHIROPRACTIC CLINCI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERROD
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-467-9233
Mailing Address - Street 1:2810 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2310
Mailing Address - Country:US
Mailing Address - Phone:817-467-9233
Mailing Address - Fax:817-468-4777
Practice Address - Street 1:2810 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2310
Practice Address - Country:US
Practice Address - Phone:817-467-9233
Practice Address - Fax:817-468-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497751218OtherNPI
TX00987XMedicare PIN