Healthcare Provider Details

I. General information

NPI: 1013922673
Provider Name (Legal Business Name): GARTH L. EDWARDS MD, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22111 GOVERNORS HWY
RICHTON PARK IL
60471-1249
US

IV. Provider business mailing address

22111 GOVERNORS HWY
RICHTON PARK IL
60471-1249
US

V. Phone/Fax

Practice location:
  • Phone: 708-748-5600
  • Fax: 708-748-5635
Mailing address:
  • Phone: 708-748-5600
  • Fax: 708-748-5635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038005184
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: