Provider Demographics
NPI:1396960084
Name:WALDRIP CHIRPORACTIC CLINIC
Entity type:Organization
Organization Name:WALDRIP CHIRPORACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:WALDRIP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:325-676-7444
Mailing Address - Street 1:3301 N 3RD ST # 134
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-7033
Mailing Address - Country:US
Mailing Address - Phone:325-676-7444
Mailing Address - Fax:325-672-5040
Practice Address - Street 1:3301 N 3RD ST # 134
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-7033
Practice Address - Country:US
Practice Address - Phone:325-676-7444
Practice Address - Fax:325-672-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherBLUE CROSS BLUE SHIELD
TX=========OtherAETNA