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General NPI Number Information
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NPI Number | 1639553886
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Entity Type | Individual
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Provider Name | JONATHAN ELDRIDGE D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 3294 WHITE MOUNTAIN HIGHWAY
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City | NORTH CONWAY
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State | NH
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Zip | 03860
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Country | US
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Telephone | 603-730-5478
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 702
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City | INTERVALE
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State | NH
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Zip | 03845-0702
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Country | US
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Telephone | 603-730-5478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 958
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License Number State | NH
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