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General NPI Number Information
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NPI Number | 1417754144
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Entity Type | Individual
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Provider Name | KAITLYN MARTIN-EDWARDS DC
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Gender | Female
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 351 N RONALD REAGAN BLVD STE 1015
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City | LONGWOOD
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State | FL
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Zip | 32750-4159
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Country | US
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Telephone | 407-417-2533
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 BERKMAN CIR FL 32771USA
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City | SANFORD
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State | FL
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Zip | 32771-6309
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Country | US
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Telephone | 912-409-2009
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH15360
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License Number State | FL
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