MEDICARE: ERIK GLENN EDWARDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301010751	MI

General Provider Information

NPI Number	:	1881167336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK GLENN EDWARDS

Provider Business Mailing Address
First Line	:	9995 RAPID CITY RD NW
Second Line	:
City	:	RAPID CITY
State	:	MI
Zip	:	49676-8412
Country	:	US
Telephone Number	:	231-331-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	9995 RAPID CITY RD NW
Second Line	:
City	:	RAPID CITY
State	:	MI
Zip	:	49676-8412
Country	:	US
Telephone Number	:	231-331-7010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	10/04/2023

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Directions to “ ERIK GLENN EDWARDS ” Practice Location

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