Provider Demographics
NPI:1457474173
Name:WALDORF CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:WALDORF CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WALDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-541-1717
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC 05658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ042116Medicare ID - Type Unspecified