MEDICARE: JOHN M. EDWARDS, D.C., P.C.

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	1266	NY

General Provider Information

NPI Number	:	1457547689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN M. EDWARDS, D.C., P.C.

Provider Business Mailing Address
First Line	:	1542 COLUMBIA TPKE
Second Line	:
City	:	CASTLETON ON HUDSON
State	:	NY
Zip	:	12033-9545
Country	:	US
Telephone Number	:	518-477-4405
Fax Number	:	518-477-2216

Provider Business Practice Location Address
First Line	:	1542 COLUMBIA TPKE
Second Line	:
City	:	CASTLETON ON HUDSON
State	:	NY
Zip	:	12033-9545
Country	:	US
Telephone Number	:	518-477-4405
Fax Number	:	518-477-2216

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN M EDWARDS
Credential	:	D.C.
Telephone Number	:	518-477-4405

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	09/21/2007

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