Provider Demographics
NPI:1750622403
Name:EDMONDS, DANIEL EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EUGENE
Last Name:EDMONDS
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 1:101 E ALEX BELL RD
Mailing Address - Street 2:SUITE 186
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2753
Mailing Address - Country:US
Mailing Address - Phone:570-594-8288
Mailing Address - Fax:
Practice Address - Street 1:101 E ALEX BELL RD
Practice Address - Street 2:SUITE 186
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2753
Practice Address - Country:US
Practice Address - Phone:570-594-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4372111NS0005X
TN2619111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician