Provider Demographics
NPI:1386621316
Name:EDWARDS, CHARLES ARCHER (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ARCHER
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:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-0346
Mailing Address - Country:US
Mailing Address - Phone:740-425-3514
Mailing Address - Fax:740-425-3514
Practice Address - Street 1:749 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-1456
Practice Address - Country:US
Practice Address - Phone:740-425-3514
Practice Address - Fax:740-425-3514
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor