Provider Demographics
NPI:1952470353
Name:WALDO, EDWARD H (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:WALDO
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 1:1317 TERRACE RD NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2236
Mailing Address - Country:US
Mailing Address - Phone:330-497-9797
Mailing Address - Fax:330-497-0029
Practice Address - Street 1:1317 TERRACE RD NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2236
Practice Address - Country:US
Practice Address - Phone:330-497-9797
Practice Address - Fax:330-497-0029
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH867111NX0800X
VT824111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450202Medicaid
OH000000132415OtherANTHEM-BC ID
OHWA0490142Medicare ID - Type UnspecifiedMEDICARE
OH000000132415OtherANTHEM-BC ID