Provider Demographics
NPI:1083690432
Name:WALDORF, ERIC ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ANTHONY
Last Name:WALDORF
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 1:1301 PRINCE RODGERS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2020
Mailing Address - Country:US
Mailing Address - Phone:908-541-1717
Mailing Address - Fax:908-541-0539
Practice Address - Street 1:1301 PRINCE RODGERS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2020
Practice Address - Country:US
Practice Address - Phone:908-541-1717
Practice Address - Fax:908-541-0539
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC 05658111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ04116Medicare ID - Type Unspecified