Healthcare Provider Details

I. General information

NPI: 1205807393
Provider Name (Legal Business Name): VALERIE G EDWARDS-PETERSON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VALERIE G EDWARDS DC

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 W LOCUST ST
CANTON IL
61520-3600
US

IV. Provider business mailing address

PO BOX 556
CANTON IL
61520-0556
US

V. Phone/Fax

Practice location:
  • Phone: 309-649-6009
  • Fax:
Mailing address:
  • Phone: 309-649-6009
  • Fax: 309-649-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009820
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: