Healthcare Provider Details

I. General information

NPI: 1013929199
Provider Name (Legal Business Name): DESIREE DEANNE EDLUND D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 JAMBOREE RD STE 118
NEWPORT BEACH CA
92660-3025
US

IV. Provider business mailing address

4425 JAMBOREE RD STE 118
NEWPORT BEACH CA
92660-3025
US

V. Phone/Fax

Practice location:
  • Phone: 949-391-7270
  • Fax:
Mailing address:
  • Phone: 949-391-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberDC26277
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: