Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 871 | IN |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 08000871A | IN |
NPI | 1396810032 |
---|---|
Provider Name | Dr. James R Edwards |
First Address | Bedford, IN 47421-3003 |
Second Address | Bedford, IN 47421-3003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 12/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00000085334 | ANTHEM BLUE CROSS BLUE SH (01) | IN |
014356 | SIHO (01) | IN |
100166180 | (05) | IN |