Provider Demographics
NPI:1649213372
Name:ELDRIDGE, DONALD PAUL (DC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:PAUL
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 1:3910 EAST PAGES LANE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2669
Mailing Address - Country:US
Mailing Address - Phone:502-937-4481
Mailing Address - Fax:
Practice Address - Street 1:3910 EAST PAGES LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2669
Practice Address - Country:US
Practice Address - Phone:502-937-4481
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000529Medicaid
KYU33746Medicare UPIN
KY0547401Medicare ID - Type Unspecified