Provider Demographics
NPI:1699530295
Name:EDWARDS, DARYN BLAKE JR (DC)
Entity type:Individual
Prefix:DR
First Name:DARYN
Middle Name:BLAKE
Last Name:EDWARDS
Suffix:JR
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 1:330 GENESIS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1638
Mailing Address - Country:US
Mailing Address - Phone:281-724-1620
Mailing Address - Fax:
Practice Address - Street 1:330 GENESIS BLVD STE B
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1638
Practice Address - Country:US
Practice Address - Phone:281-724-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty