Provider Demographics
NPI:1811908239
Name:EARHART, EDWARD (DC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:EARHART
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 1:1301 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-2022
Mailing Address - Country:US
Mailing Address - Phone:402-228-3535
Mailing Address - Fax:402-228-7398
Practice Address - Street 1:1301 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2022
Practice Address - Country:US
Practice Address - Phone:402-228-3535
Practice Address - Fax:402-228-7398
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076735100Medicaid
NE47076735100Medicaid
NE098089Medicare ID - Type Unspecified