Provider Demographics
NPI:1760778245
Name:DR. T RANDALL ELDRIDGE DC
Entity Type:Organization
Organization Name:DR. T RANDALL ELDRIDGE DC
Other - Org Name:DENVER INTEGRATED SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-758-9000
Mailing Address - Street 1:7535 E HAMPDEN AVENUE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231
Mailing Address - Country:US
Mailing Address - Phone:303-798-9000
Mailing Address - Fax:303-996-2660
Practice Address - Street 1:7535 E HAMPDEN AVENUE
Practice Address - Street 2:SUITE 405
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231
Practice Address - Country:US
Practice Address - Phone:303-798-9000
Practice Address - Fax:303-996-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU41146Medicare UPIN