Individual
RUSSELL D EDGAR
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
6934 BEACH DR SW, SUITE 2, OCEAN ISLE BEACH, NC 28469-5797
(910) 575-7809
(910) 575-7810
Mailing address
PO BOX 6931, OCEAN ISLE BEACH, NC 28469-0931
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2207
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7908776
—
NC
Enumeration date
03/16/2006
Last updated
07/08/2007
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