Provider Demographics
NPI:1295175776
Name:EDWARDS, CORIAN DELON (CMT, LMT)
Entity type:Individual
Prefix:MR
First Name:CORIAN
Middle Name:DELON
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:CMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G3277 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3615
Mailing Address - Country:US
Mailing Address - Phone:810-282-4278
Mailing Address - Fax:810-396-6117
Practice Address - Street 1:G3277 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3615
Practice Address - Country:US
Practice Address - Phone:810-282-4278
Practice Address - Fax:810-396-6117
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist