Provider Demographics
NPI:1871755694
Name:LONNIE L EDWARDS
Entity type:Organization
Organization Name:LONNIE L EDWARDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-385-2233
Mailing Address - Street 1:1288N STATE RD 65
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-9515
Mailing Address - Country:US
Mailing Address - Phone:812-385-2233
Mailing Address - Fax:
Practice Address - Street 1:1288N STATE RD 65
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-9515
Practice Address - Country:US
Practice Address - Phone:812-385-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000583A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN350040333OtherRAILROAD MEDICARE
IN100122110AMedicaid
IN000000084813OtherBC /BS
INED280920Medicare PIN
IN100122110AMedicaid