Physician Compare National (NPI:1376568071)

HEALTHCARE PROVIDER: EDIST JEEMS LOVE DC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1376568071
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1153451604
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100610000495
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LOVE
	Individual professional last name
Provider First Name	EDIST
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NATIONAL COLLEGE OF CHIROPRACTIC
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	351 S MAIN ST
	Group Practice or individual's line 1 address
City	KILMARNOCK
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	224821447
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M