Provider Demographics
NPI:1891847737
Name:WALDRON, TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:WALDRON
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 1:11201 SHAKER BLVD
Mailing Address - Street 2:STE 322
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3871
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6508 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-3014
Practice Address - Country:US
Practice Address - Phone:216-334-1401
Practice Address - Fax:216-334-1409
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2193764Medicaid
OHWA4117672Medicare ID - Type Unspecified
OHU94894Medicare UPIN