Provider Demographics
NPI:1396772570
Name:EDISON, SEAN T (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:T
Last Name:EDISON
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 1:105 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1951
Mailing Address - Country:US
Mailing Address - Phone:517-423-3600
Mailing Address - Fax:517-423-1452
Practice Address - Street 1:105 S PEARL ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1951
Practice Address - Country:US
Practice Address - Phone:517-423-3600
Practice Address - Fax:517-423-1452
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISE007601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D61135OtherBCBS OF MICHIGAN
MI0D65031OtherBCBS
MI144189520Medicaid
MI144189520Medicaid
MIM98810001Medicare PIN