Healthcare Provider Details

I. General information

NPI: 1396725776
Provider Name (Legal Business Name): DENNIS ORAL EDWARDS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E MAIN
ANTHON IA
51004-0475
US

IV. Provider business mailing address

PO BOX 475 206 E MAIN
ANTHON IA
51004-0475
US

V. Phone/Fax

Practice location:
  • Phone: 712-373-5512
  • Fax:
Mailing address:
  • Phone: 712-373-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number04567
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: