Provider Demographics
NPI:1780966887
Name:EDGERTON, ERIC (DC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:EDGERTON
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 1:29901 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1041
Mailing Address - Country:US
Mailing Address - Phone:727-286-6203
Mailing Address - Fax:727-286-6204
Practice Address - Street 1:29901 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-1041
Practice Address - Country:US
Practice Address - Phone:727-286-6203
Practice Address - Fax:727-286-6204
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12323896OtherCAQH
FL220HDOtherBCBS