Healthcare Provider Details

I. General information

NPI: 1396810032
Provider Name (Legal Business Name): JAMES R EDWARDS DC DABCO LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 16TH ST
BEDFORD IN
47421-3003
US

IV. Provider business mailing address

2129 16TH ST
BEDFORD IN
47421-3003
US

V. Phone/Fax

Practice location:
  • Phone: 812-275-3323
  • Fax: 812-277-9354
Mailing address:
  • Phone: 812-275-3323
  • Fax: 812-277-9354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number08000871A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number871
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number81000034A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: