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General NPI Number Information
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NPI Number | 1396810032
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Entity Type | Individual
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Provider Name | JAMES R EDWARDS DC DABCO LAC
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 2129 16TH ST
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City | BEDFORD
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State | IN
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Zip | 47421-3003
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Country | US
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Telephone | 812-275-3323
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Fax | 812-277-9354
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Provider Business Mailing Address
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Address Line | 2129 16TH ST
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City | BEDFORD
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State | IN
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Zip | 47421-3003
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Country | US
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Telephone | 812-275-3323
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Fax | 812-277-9354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 08000871A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 871
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 81000034A
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License Number State | IN
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