Provider Demographics
NPI:1558430959
Name:WALDO CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:WALDO CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-497-9797
Mailing Address - Street 1:1317 TERRACE RD NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2236
Mailing Address - Country:US
Mailing Address - Phone:330-497-9797
Mailing Address - Fax:330-497-0029
Practice Address - Street 1:1317 TERRACE RD NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2236
Practice Address - Country:US
Practice Address - Phone:330-497-9797
Practice Address - Fax:330-497-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH867111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000132415OtherANTHEM-BLUE CROSS ID
OH0450202Medicaid
OH000000132415OtherANTHEM-BLUE CROSS ID