Provider Demographics
NPI:1730264615
Name:PRIEM, EDWARD JAMES (DC, PT, DPT)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAMES
Last Name:PRIEM
Suffix:
Gender:M
Credentials:DC, PT, DPT
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:JAMES
Other - Last Name:PRIEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, PT, DPT
Mailing Address - Street 1:661 THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155
Mailing Address - Country:US
Mailing Address - Phone:304-455-6824
Mailing Address - Fax:304-455-6825
Practice Address - Street 1:661 THIRD STREET
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155
Practice Address - Country:US
Practice Address - Phone:304-455-6824
Practice Address - Fax:304-455-6825
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV656111N00000X
WV2547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0312277000Medicaid
WV0312277000Medicaid