Provider Demographics
NPI:1285979203
Name:ELDRIDGE, CHAD AUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:AUSTIN
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W CANTON AVE
Mailing Address - Street 2:SUITE 275A
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3154
Mailing Address - Country:US
Mailing Address - Phone:407-906-2415
Mailing Address - Fax:
Practice Address - Street 1:201 W CANTON AVE
Practice Address - Street 2:SUITE 275A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3154
Practice Address - Country:US
Practice Address - Phone:407-906-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor