Provider Demographics
NPI:1902917016
Name:EDMONDS, DARREN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:JAMES
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:PO BOX 21962
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34276-4962
Mailing Address - Country:US
Mailing Address - Phone:941-365-8555
Mailing Address - Fax:941-758-3577
Practice Address - Street 1:3139 SOUTHGATE CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5515
Practice Address - Country:US
Practice Address - Phone:941-365-8555
Practice Address - Fax:941-758-3577
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70249OtherBLUE CROSS PROVIDER #
FL38175100Medicaid
FLE5453AMedicare ID - Type UnspecifiedPROVIDER #
FL70249OtherBLUE CROSS PROVIDER #
FL38175100Medicaid