Provider Demographics
NPI:1770593378
Name:WALDRON, CHARLES THOMAS (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:THOMAS
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 1:107 RIVER AVE
Mailing Address - Street 2:GOLD'S GYM BUILDING
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2563
Mailing Address - Country:US
Mailing Address - Phone:732-899-5660
Mailing Address - Fax:
Practice Address - Street 1:107 RIVER AVE
Practice Address - Street 2:GOLD'S GYM BUILDING
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-2563
Practice Address - Country:US
Practice Address - Phone:732-899-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00249400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor