Healthcare Provider Details

I. General information

NPI: 1538609490
Provider Name (Legal Business Name): ADRIAN MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 US HIGHWAY 223
ADRIAN MI
49221-1242
US

IV. Provider business mailing address

1921 US HIGHWAY 223
ADRIAN MI
49221-1242
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-2900
  • Fax: 517-263-9250
Mailing address:
  • Phone: 517-263-2900
  • Fax: 517-263-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAD WILLIAM EDISON
Title or Position: OWNDER
Credential: DC
Phone: 517-263-2900