Provider Demographics
NPI:1508954256
Name:ELDRIDGE, THOMAS R (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:ELDRIDGE
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 1:7007 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3011
Mailing Address - Country:US
Mailing Address - Phone:303-758-9000
Mailing Address - Fax:303-996-2660
Practice Address - Street 1:7007 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3011
Practice Address - Country:US
Practice Address - Phone:303-758-9000
Practice Address - Fax:303-996-2660
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841137057OtherTAX ID