Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 2521 | MA |
Y | 111NS0005X | Chiropractic Sports Physician | 60289583 | WA |
NPI | 1194802801 |
---|---|
Provider Name | Dr. Jeffry Waldrop |
First Address | Everett, WA 98204-6926 |
Second Address | Everett, WA 98204-6926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 01/10/2012 |