Provider Demographics
NPI:1699977561
Name:ELDRIDGE CHIROPRACTIC PS
Entity type:Organization
Organization Name:ELDRIDGE CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:509-982-2880
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:WA
Mailing Address - Zip Code:99159-0560
Mailing Address - Country:US
Mailing Address - Phone:509-982-2880
Mailing Address - Fax:
Practice Address - Street 1:18 W. 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:WA
Practice Address - Zip Code:99159
Practice Address - Country:US
Practice Address - Phone:509-982-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty