Provider Demographics
NPI:1386952695
Name:CUNNINGHAM, EDWARD (RN, LAC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 MALINDA RD
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075-2417
Mailing Address - Country:US
Mailing Address - Phone:215-233-4505
Mailing Address - Fax:
Practice Address - Street 1:1208 MALINDA RD
Practice Address - Street 2:
Practice Address - City:ORELAND
Practice Address - State:PA
Practice Address - Zip Code:19075-2417
Practice Address - Country:US
Practice Address - Phone:215-233-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO000513171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist