Provider Demographics
NPI:1811659725
Name:EDWARDS, BRENDA LA-DONNA (DC)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:LA-DONNA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LADONNA
Other - Last Name:YETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:13221 BUNDORAN CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1145
Mailing Address - Country:US
Mailing Address - Phone:773-398-9201
Mailing Address - Fax:
Practice Address - Street 1:13221 BUNDORAN CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1145
Practice Address - Country:US
Practice Address - Phone:773-398-9201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor