Provider Demographics
NPI:1952580193
Name:ROBERT V EDWARDS DCPC
Entity Type:Organization
Organization Name:ROBERT V EDWARDS DCPC
Other - Org Name:EDWARDS CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-836-3771
Mailing Address - Street 1:5300 SEQUOIA RD NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1284
Mailing Address - Country:US
Mailing Address - Phone:505-836-3771
Mailing Address - Fax:505-836-5282
Practice Address - Street 1:5300 SEQUOIA RD NW
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1284
Practice Address - Country:US
Practice Address - Phone:505-836-3771
Practice Address - Fax:505-836-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMOOKB99OtherBCBS