Provider Demographics
NPI:1285904292
Name:EDWARDS, ROBERT JAKE (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAKE
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 1:4604 N SAGINAW RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2387
Mailing Address - Country:US
Mailing Address - Phone:989-832-7535
Mailing Address - Fax:989-832-1631
Practice Address - Street 1:4604 N SAGINAW RD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2387
Practice Address - Country:US
Practice Address - Phone:989-832-7535
Practice Address - Fax:989-832-1631
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor