MEDICARE: EDWARDS CHIROPRACTIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1245221399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARDS CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	4558 SAN JUAN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2051
Country	:	US
Telephone Number	:	904-389-0667
Fax Number	:	904-389-5871

Provider Business Practice Location Address
First Line	:	4558 SAN JUAN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2051
Country	:	US
Telephone Number	:	904-389-0667
Fax Number	:	904-389-5871

Authorized Official
Title or Position	:	PRESIDENT OF PA
Name	:	HARRY D EDWARDS
Credential	:	DC
Telephone Number	:	904-389-0667

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

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Practice Location Address:

4558 SAN JUAN AVE
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1134215213 — BRENDA K KNOWLES LMT
Practice Location Address:

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Practice Location Address:

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1558420810 — MR. EHAB M ABDELMALEK
Practice Location Address:

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Practice Location Address:

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1396869160 — EHAB REHAB, INC. DBA APEX PHYSICAL THERAPY
Practice Location Address:

4558 SAN JUAN AVE STE B
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