Provider Demographics
NPI:1134344971
Name:EDWARDS, GERALD K (DC)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:K
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 1:3855 HUGHES AVE
Mailing Address - Street 2:#200
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2729
Mailing Address - Country:US
Mailing Address - Phone:310-838-2225
Mailing Address - Fax:310-838-3777
Practice Address - Street 1:3855 HUGHES AVE
Practice Address - Street 2:#200
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2729
Practice Address - Country:US
Practice Address - Phone:310-838-2225
Practice Address - Fax:310-838-3777
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22322Medicare ID - Type Unspecified
CAU57895Medicare UPIN