Healthcare Provider Details

I. General information

NPI: 1386621316
Provider Name (Legal Business Name): CHARLES ARCHER EDWARDS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 E MAIN ST
BARNESVILLE OH
43713-1456
US

IV. Provider business mailing address

PO BOX 346
BARNESVILLE OH
43713-0346
US

V. Phone/Fax

Practice location:
  • Phone: 740-425-3514
  • Fax: 740-425-3514
Mailing address:
  • Phone: 740-425-3514
  • Fax: 740-425-3514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number359
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: