Provider Demographics
NPI:1932164159
Name:ELDRIDGE, TERRY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:ELDRIDGE
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 1:7440 W CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-9534
Mailing Address - Country:US
Mailing Address - Phone:623-878-9388
Mailing Address - Fax:623-878-9114
Practice Address - Street 1:7440 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-9534
Practice Address - Country:US
Practice Address - Phone:623-878-9388
Practice Address - Fax:623-878-9114
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00160715OtherRRMEDICARE
AZP00160715OtherRRMEDICARE
AZT93284Medicare UPIN