Healthcare Provider Details

I. General information

NPI: 1730264615
Provider Name (Legal Business Name): EDWARD JAMES PRIEM DC, PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDWARD JAMES PRIEM DC, PT, DPT

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 THIRD STREET
NEW MARTINSVILLE WV
26155
US

IV. Provider business mailing address

661 THIRD STREET
NEW MARTINSVILLE WV
26155
US

V. Phone/Fax

Practice location:
  • Phone: 304-455-6824
  • Fax: 304-455-6825
Mailing address:
  • Phone: 304-455-6824
  • Fax: 304-455-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number656
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2547
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: