Provider Demographics
NPI:1144369661
Name:EDWARDS, PAULA C (DC)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:C
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4311
Mailing Address - Country:US
Mailing Address - Phone:563-242-3022
Mailing Address - Fax:563-242-3035
Practice Address - Street 1:232 4TH AVE S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4311
Practice Address - Country:US
Practice Address - Phone:563-242-3022
Practice Address - Fax:563-242-3035
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0453399Medicaid
IA0453399Medicaid