Garth L. Edwards, MD, DC
Individual provider Active NPI Chiropractor · Richton Park, IL
NPI 1013922673 · NPPES record last updated Sep 22, 2015
Key facts
- NPI
- 1013922673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038005184 (IL)
- Practice address
- 22111 Governors Hwy
Richton Park, IL 60471-1249 - Phone
- (708) 748-5600
- Fax
- (708) 748-5635
- NPI assigned
- Jul 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Other, 1983
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
22111 Governors Hwy
Richton Park, IL 60471-1249
Phone (708) 748-5600
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080401000866 | IL | Practitioner - Chiropractic | 1254418296 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038005184 | IL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edwards Chiropractic Clinic | Chiropractor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038005184 | IL | Yes |
Addresses
Primary practice location
22111 Governors Hwy
Richton Park, IL 60471-1249
Mailing address
22111 Governors Hwy
Richton Park, IL 60471-1249
Phone (708) 748-5600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 723620 | Other | IL | PTAN |
| 1013922673 | Other | IL | NPI |
Other providers in Richton Park, IL
- Dove Mandela
- Dove Mandela
- Maceo Edmonds
- Edwards Chiropractic Clinic
- Edwards Chiropractic Clinic P.C
- Elite Life Skills Coaching
- Faith Is Key Counseling LLC
- Family Eye Centers LLC
- Mary Elizabeth Fleming
- Candy A Flemister
All providers in Richton Park, IL · Chiropractor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.