Provider Demographics
NPI:1336469766
Name:ELDRIDGE, JOHN D (NMD, DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:NMD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2332
Mailing Address - Country:US
Mailing Address - Phone:602-265-8414
Mailing Address - Fax:602-265-2091
Practice Address - Street 1:3522 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2332
Practice Address - Country:US
Practice Address - Phone:602-265-8414
Practice Address - Fax:602-265-2091
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ916111NR0400X
AZ77319175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111NR0400XChiropractic ProvidersChiropractorRehabilitation