Provider Demographics
NPI:1023071461
Name:EDWARDS, KEVIN A (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:EDWARDS
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 1:76 GREENSBURG ST
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1416
Mailing Address - Country:US
Mailing Address - Phone:724-468-1155
Mailing Address - Fax:
Practice Address - Street 1:76 GREENSBURG ST
Practice Address - Street 2:
Practice Address - City:DELMONT
Practice Address - State:PA
Practice Address - Zip Code:15626-1416
Practice Address - Country:US
Practice Address - Phone:724-468-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007065L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA027-209Medicare ID - Type Unspecified