Provider Demographics
NPI:1790500361
Name:EDWARDS, MICHEALA E (DC)
Entity type:Individual
Prefix:DR
First Name:MICHEALA
Middle Name:E
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 1:8116 SE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-5236
Mailing Address - Country:US
Mailing Address - Phone:816-877-9450
Mailing Address - Fax:
Practice Address - Street 1:8116 SE 6TH ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-5236
Practice Address - Country:US
Practice Address - Phone:816-877-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ2021012401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor