Provider Demographics
NPI:1699119057
Name:EDWARDS, CHRISTIAN (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
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 1:515 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7011
Mailing Address - Country:US
Mailing Address - Phone:386-402-8997
Mailing Address - Fax:800-483-2093
Practice Address - Street 1:515 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7011
Practice Address - Country:US
Practice Address - Phone:386-402-8997
Practice Address - Fax:800-483-2093
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor