Provider Demographics
NPI:1699961532
Name:DR. EDWARD M. FRISBEE CANTER FOR HEATHLY LIVING
Entity type:Organization
Organization Name:DR. EDWARD M. FRISBEE CANTER FOR HEATHLY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-862-4313
Mailing Address - Street 1:119 TRUXTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2460
Mailing Address - Country:US
Mailing Address - Phone:850-862-4313
Mailing Address - Fax:850-863-1765
Practice Address - Street 1:119 TRUXTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2460
Practice Address - Country:US
Practice Address - Phone:850-862-4313
Practice Address - Fax:850-863-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty