Healthcare Provider Details

I. General information

NPI: 1457474173
Provider Name (Legal Business Name): WALDORF CHIROPRACTIC CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PRINCE RODGERS AVE
BRIDGEWATER NJ
08807-2020
US

IV. Provider business mailing address

1301 PRINCE RODGERS AVE
BRIDGEWATER NJ
08807-2020
US

V. Phone/Fax

Practice location:
  • Phone: 908-541-1717
  • Fax: 908-541-0539
Mailing address:
  • Phone: 908-541-1717
  • Fax: 908-541-0539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC 05658
License Number StateNJ

VIII. Authorized Official

Name: DR. ERIC ANTHONY WALDORF
Title or Position: PRESIDENT
Credential: DC
Phone: 908-541-1717