Provider Demographics
NPI:1972590792
Name:EDMONDS, DECHEZ ALMONT (DC)
Entity type:Individual
Prefix:
First Name:DECHEZ
Middle Name:ALMONT
Last Name:EDMONDS
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 1:12419 DEERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4672
Mailing Address - Country:US
Mailing Address - Phone:317-770-6000
Mailing Address - Fax:
Practice Address - Street 1:12419 DEERVIEW DR
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4672
Practice Address - Country:US
Practice Address - Phone:317-770-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002179A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20014460Medicaid
U60694Medicare UPIN
168840Medicare ID - Type Unspecified