Provider Demographics
NPI:1891845046
Name:ELDRIDGE, TROY D SR (DC)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:D
Last Name:ELDRIDGE
Suffix:SR
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:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:WA
Mailing Address - Zip Code:99159-0560
Mailing Address - Country:US
Mailing Address - Phone:509-982-2880
Mailing Address - Fax:
Practice Address - Street 1:18 W. 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:WA
Practice Address - Zip Code:99159
Practice Address - Country:US
Practice Address - Phone:509-982-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025202 CH00003217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA106781OtherLABOR & INDUSTRIES
WA2021327Medicaid
WA2021327Medicaid