Provider Demographics
NPI:1245532936
Name:EDG COMPANY LLC
Entity type:Organization
Organization Name:EDG COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-210-2212
Mailing Address - Street 1:14438 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3217
Mailing Address - Country:US
Mailing Address - Phone:402-210-2212
Mailing Address - Fax:402-408-9739
Practice Address - Street 1:14438 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3217
Practice Address - Country:US
Practice Address - Phone:402-210-2212
Practice Address - Fax:402-408-9739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty