1952580193 NPI number — ROBERT V EDWARDS DCPC

Table of content: (NPI 1952580193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952580193 NPI number — ROBERT V EDWARDS DCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT V EDWARDS DCPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EDWARDS CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952580193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 SEQUOIA RD NW
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87120-1284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-836-3771
Provider Business Mailing Address Fax Number:
505-836-5282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 SEQUOIA RD NW
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87120-1284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-836-3771
Provider Business Practice Location Address Fax Number:
505-836-5282
Provider Enumeration Date:
10/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
PC
Authorized Official Telephone Number:
505-836-3771

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1148 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NMOOKB99 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com