Healthcare Provider Details

I. General information

NPI: 1285950113
Provider Name (Legal Business Name): EDGE FAMILY CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8124 PENSACOLA BLVD
PENSACOLA FL
32534-4354
US

IV. Provider business mailing address

8124 PENSACOLA BLVD
PENSACOLA FL
32534-4354
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-7117
  • Fax: 850-479-4622
Mailing address:
  • Phone: 850-476-7117
  • Fax: 850-479-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0005258
License Number StateFL

VIII. Authorized Official

Name: MR. GREGORY STEWART
Title or Position: DIRECTOR
Credential:
Phone: 850-476-7117