Provider Demographics
NPI:1396882924
Name:EDWARDS CHIROPRACTIC WELLNESS CENTER, P.A.
Entity type:Organization
Organization Name:EDWARDS CHIROPRACTIC WELLNESS CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:N
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-479-3281
Mailing Address - Street 1:803 HIGHWAY 15-401 BYPASS WEST
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512
Mailing Address - Country:US
Mailing Address - Phone:843-479-3281
Mailing Address - Fax:843-479-5446
Practice Address - Street 1:803 HIGHWAY 15-401 BYPASS WEST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:843-479-3281
Practice Address - Fax:843-479-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty