| Doctor Name: | KIRT LEE EDLY |
| NPI Number: | 1053575746 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.C., P.A. |
| License Number: | 085003072 |
| Business Practice Address: | 39000 Bob Hope Dr Harry & Diane Rinker Building Rancho Mirage, CA - 922703221 |
| Business Phone Number: | 7605682684 |
| Business Fax Number: | 7698372202 |
| Mailing Address: | Po Box 1810, RANCHO MIRAGE |
| State: | CA |
| Postal Code: | 922701059 |
| Phone Number: | 7607661250 |
| Fax Number: | 7608372202 |
| NPI Enumeration Date: | 07/11/2008 |
| NPI Last Update Date: | 01/31/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 085003072 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |