Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 916 | AZ |
Y | 175F00000X | Naturopath | 77319 | AZ |
NPI | 1336469766 |
---|---|
Provider Name | Dr. John D Eldridge |
First Address | Phoenix, AZ 85012-2332 |
Second Address | Phoenix, AZ 85012-2332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2010 |
Last Update Date | 08/06/2010 |