Provider Demographics
NPI:1215952635
Name:EDWARDS, GERALD LEONARD (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LEONARD
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 GRANT DR
Mailing Address - Street 2:STE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5323
Mailing Address - Country:US
Mailing Address - Phone:775-824-0444
Mailing Address - Fax:775-824-0217
Practice Address - Street 1:5083 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6530
Practice Address - Country:US
Practice Address - Phone:775-824-0444
Practice Address - Fax:775-824-0217
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB02006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor