Provider Demographics
NPI:1205807393
Name:EDWARDS-PETERSON, VALERIE G (DC)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:G
Last Name:EDWARDS-PETERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:G
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-0556
Mailing Address - Country:US
Mailing Address - Phone:309-649-6009
Mailing Address - Fax:309-649-6909
Practice Address - Street 1:416 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-3600
Practice Address - Country:US
Practice Address - Phone:309-649-6009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009820111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU93469Medicare UPIN
IAI8092Medicare ID - Type UnspecifiedIOWA MEDCARE