Individual
DR. STACY KENTON EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
130 N. BROADWAY, SUITE #1, BEREA, KY 40403
(859) 986-9477
(859) 985-7876
Mailing address
PO BOX 957, 130 N. BROADWAY SUITE #1, BEREA, KY 40403
(859) 986-9477
(859) 985-7876
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4066
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000069105
BCBS
KY
Enumeration date
12/28/2006
Last updated
03/18/2009
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