Provider Demographics
NPI:1700934239
Name:EDWARDS, GREGORY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
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 1:111 BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1444
Mailing Address - Country:US
Mailing Address - Phone:814-308-9397
Mailing Address - Fax:
Practice Address - Street 1:20916 STUBBLE RD
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3104
Practice Address - Country:US
Practice Address - Phone:703-858-4400
Practice Address - Fax:703-858-4663
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor