Healthcare Provider Details

I. General information

NPI: 1265575765
Provider Name (Legal Business Name): EDGERTON CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SOUTH MAIN STREET
SHELBY NC
28152
US

IV. Provider business mailing address

PO BOX 1141
BOILING SPRINGS NC
28017
US

V. Phone/Fax

Practice location:
  • Phone: 704-434-9130
  • Fax: 704-434-9142
Mailing address:
  • Phone: 704-434-9130
  • Fax: 704-434-9923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1735
License Number StateNC

VIII. Authorized Official

Name: DR. DAVID EZRA EDGERTON
Title or Position: OWNER
Credential: D.C.
Phone: 704-434-9130