MEDICARE: DR. EDWARD H WALDO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	867	OH
2	111NX0800X	Orthopedic Chiropractor	824	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000132415	OTHER	OH	ANTHEM-BC ID

General Provider Information

NPI Number	:	1952470353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD H WALDO D.C.

Provider Business Mailing Address
First Line	:	1317 TERRACE RD NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2236
Country	:	US
Telephone Number	:	330-497-9797
Fax Number	:	330-497-0029

Provider Business Practice Location Address
First Line	:	1317 TERRACE RD NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2236
Country	:	US
Telephone Number	:	330-497-9797
Fax Number	:	330-497-0029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. EDWARD H WALDO D.C.” Practice Location

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