# EDWARDS CHIROPRACTIC CLINIC P.C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164649976
- **Authorized official:** GARTH L EDWARDS MD,DC,MHS,DACBN,CCN (OWNER)
- **Authorized official phone:** (708) 748-5600

## Contact information

- **Practice address:** 22111 GOVERNORS HWY, RICHTON PARK, IL 60471-1249
- **Practice address phone:** (708) 747-5600
- **Practice address fax:** (708) 748-5635
- **Mailing address:** 1824 HEATHER HILL CRES, FLOSSMOOR, IL 60422-2000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NN1001X | Nutrition Chiropractor | — | IL | Yes |

## Other

- **Enumeration date:** 04/20/2007
- **Last updated:** 03/26/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1013922673 | NPI INDIVIDUAL | IL |
| 01 | — | 1645747 | BCBS PROVIDER | IL |