Provider Demographics
NPI:1235211913
Name:WALDROP, STEPHEN C (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:WALDROP
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:PO BOX 79178
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1515
Mailing Address - Country:US
Mailing Address - Phone:817-847-7246
Mailing Address - Fax:817-847-7247
Practice Address - Street 1:211 W MCLEROY BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1515
Practice Address - Country:US
Practice Address - Phone:817-847-7246
Practice Address - Fax:817-847-7247
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4065680OtherAETNA PROVIDER NUMBER
TX601917OtherBLUE CROSS
TX8116447OtherBLUELINK
TX4065680OtherAETNA PROVIDER NUMBER