Provider Demographics
NPI:1235314386
Name:ELDREDGE, NATHAN TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:TYLER
Last Name:ELDREDGE
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 1:4692 S RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3810
Mailing Address - Country:US
Mailing Address - Phone:801-590-8494
Mailing Address - Fax:
Practice Address - Street 1:720 E NEW ENGLAND DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3590
Practice Address - Country:US
Practice Address - Phone:801-569-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5501297-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor