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General NPI Number Information
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NPI Number | 1356663371
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Entity Type | Organization
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Legal Business Name | EDISON CHIROPRACTOR CENTER INC
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 6325 PRESIDENTIAL CT STE 2
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City | FORT MYERS
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State | FL
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Zip | 33919-3515
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Country | US
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Telephone | 239-689-5555
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Fax | 239-689-5556
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Provider Business Mailing Address
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Address Line | 6325 PRESIDENTIAL CT STE 2
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City | FORT MYERS
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State | FL
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Zip | 33919-3515
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Country | US
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Telephone | 239-689-5555
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Fax | 239-689-5556
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM A HALL
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Credential | DC
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Telephone | 239-689-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | CH 6817
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License Number State | FL
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