Provider Demographics
NPI:1609029669
Name:WALDROUP, ELWOOD EARL (DC)
Entity Type:Individual
Prefix:DR
First Name:ELWOOD
Middle Name:EARL
Last Name:WALDROUP
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 1:1261 S SEWARD MERIDIAN PKWY
Mailing Address - Street 2:STE. F
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8372
Mailing Address - Country:US
Mailing Address - Phone:907-357-6100
Mailing Address - Fax:907-357-6102
Practice Address - Street 1:1261 S SEWARD MERIDIAN PKWY
Practice Address - Street 2:STE. F
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8372
Practice Address - Country:US
Practice Address - Phone:907-357-6100
Practice Address - Fax:907-357-6102
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK88111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor