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General NPI Number Information
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NPI Number | 1659904720
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Entity Type | Organization
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Legal Business Name | THE EDGE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 4 PEARL DR STE 1
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City | ORMOND BEACH
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State | FL
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Zip | 32174-1927
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Country | US
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Telephone | 386-290-6007
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Fax |
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Provider Business Mailing Address
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Address Line | 132 RIVER BLUFF DR
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City | ORMOND BEACH
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State | FL
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Zip | 32174-3833
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Country | US
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Telephone | 410-200-0029
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Fax |
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Authorized Official
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Title or Position | OWNER/ OPERATOR
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Name | MR. JASON DEAN DUNLAP
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Credential | DC
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Telephone | 410-200-0029
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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 |
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License Number State |
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