Provider Demographics
NPI:1699878173
Name:BICE, EDWIN W III (DC)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:W
Last Name:BICE
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 4090
Mailing Address - Street 2:552 WILLIAMSON RD.
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4090
Mailing Address - Country:US
Mailing Address - Phone:704-236-0109
Mailing Address - Fax:704-658-1400
Practice Address - Street 1:552 WILLIAMSON RD.
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-664-6932
Practice Address - Fax:704-660-6932
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2453909Medicare ID - Type Unspecified
U76758Medicare UPIN