Provider Demographics
NPI:1336153519
Name:EDWARDS, HEATH L (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATH
Middle Name:L
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 1:104 JOHN STARK HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-2120
Mailing Address - Country:US
Mailing Address - Phone:603-863-6680
Mailing Address - Fax:603-863-2967
Practice Address - Street 1:104 JOHN STARK HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-2120
Practice Address - Country:US
Practice Address - Phone:603-863-6680
Practice Address - Fax:603-863-2967
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5300498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE4832Medicare ID - Type Unspecified
NHU70697Medicare UPIN