Provider Demographics
NPI:1912077173
Name:EDWARDS, YVETTE ERICA (DC)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:ERICA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5754
Mailing Address - Country:US
Mailing Address - Phone:864-288-2136
Mailing Address - Fax:864-288-6818
Practice Address - Street 1:1272 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5754
Practice Address - Country:US
Practice Address - Phone:864-288-2136
Practice Address - Fax:864-288-6818
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA07990281Medicare ID - Type Unspecified