Provider Demographics
NPI:1881242683
Name:ELDRIDGE, MIKAYLA STORM (DC)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:STORM
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:STORM
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5209 SKYLANE DR
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-3258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 N GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7214
Practice Address - Country:US
Practice Address - Phone:918-802-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4427111N00000X
NH1044111N00000X
NH1059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor