10D2165499 CLIA NUMBER - EDGEWATER CHIROPRACTIC CLINIC PA

Laboratory Demographics

CLIA Number: 10D2165499

Facility Name: EDGEWATER CHIROPRACTIC CLINIC PA

Facility Address:
201 S RIDGEWOOD AVE STE #11
EDGEWATER, FL
ZIP 32132
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Facility Phone Number: 386 423-7575

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1821421363

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	10D2165499
LAB Type	Physician Office
Facility Name	EDGEWATER CHIROPRACTIC CLINIC PA
Street	201 S RIDGEWOOD AVE STE #11
City	EDGEWATER
State	FL
ZIP	32132
Phone	386 423-7575
CertificateType	4
CertificateEffectiveDate	4/30/2023
CertificateExpirationDate	4/29/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024