Provider Demographics
NPI:1295881423
Name:EDMONDSON, DAVID R (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:EDMONDSON
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 1:623 CAREY WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6916
Mailing Address - Country:US
Mailing Address - Phone:407-468-3857
Mailing Address - Fax:
Practice Address - Street 1:1318 E VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3624
Practice Address - Country:US
Practice Address - Phone:407-935-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7128111N00000X
AL1732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55627OtherBLUECROSSBLUESHIELD
FL606780OtherUNITED HEALTH CARE