Active NPI
James R Edwards, DC DABCO LAC
- Chiropractor
- Bedford, IN
National Provider Identifier
1396810032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 871
- Practice address
- 2129 16TH St
Bedford, IN 47421-3003 - Phone
- (812) 275-3323
- Fax
- (812) 277-9354
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Chiropractor | 111NX0800X | 08000871A | IN | |
| Chiropractor | 111N00000X | 871 | IN | Primary |
| Acupuncturist | 171100000X | 81000034A | IN |
Addresses
Primary practice location
2129 16TH St
Bedford, IN 47421-3003
Mailing address
2129 16TH St
Bedford, IN 47421-3003
Phone (812) 275-3323
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000085334 | Other | IN | ANTHEM BLUE CROSS BLUE SH |
| 100166180 | Medicaid | IN | |
| 014356 | Other | IN | SIHO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050115000054 | IN | Practitioner - Chiropractic | 6103875224 | Practice locations: Bedford, IN |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 871 | IN | MD | Chiropractor |
| 08000871A | IN | MD | Orthopedic Chiropractor |
| 81000034A | IN | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573516800000",
"number": "1396810032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2129 16TH ST",
"city": "BEDFORD",
"state": "IN",
"postal_code": "474213003",
"telephone_number": "812-275-3323",
"fax_number": "812-277-9354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2129 16TH ST",
"city": "BEDFORD",
"state": "IN",
"postal_code": "474213003",
"telephone_number": "812-275-3323",
"fax_number": "812-277-9354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "JAMES",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DC DABCO LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2019-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "111NX0800X",
"taxonomy_group": "",
"desc": "Chiropractor, Orthopedic",
"state": "IN",
"license": "08000871A",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IN",
"license": "871",
"primary": true
},
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "IN",
"license": "81000034A",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS BLUE SH",
"identifier": "00000085334",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100166180",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIHO",
"identifier": "014356",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bedford, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.