=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679642813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD CHARLES RAYMOND DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 08/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 358 EAST ST
-----------------------------------------------------
City | PITTSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27312-9722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-542-6107
-----------------------------------------------------
Fax | 919-542-6107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 THOMPSON ST STE 205
-----------------------------------------------------
City | PITTSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27312-5511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-542-6107
-----------------------------------------------------
Fax | 919-490-5455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1725
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------