Etheridge Chiropractic Clinic Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

08001352 Issued in IN

Legal business name

ETHERIDGE CHIROPRACTIC CLINIC INC

Practice address

631 S 25TH Street
Terre Haute, IN 47803

Phone

(812) 232-8803

Fax

(812) 232-1305

NPI assigned

Sep 28, 2007

Reactivated

Jul 10, 2009

Organization subpart

No

Name

Dr. Eugene W Etheridge Jr., DCNPI 1427168517

Title

Doctor

Phone

(812) 232-8803

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eugene Wesley Etheridge Jr., DC

  • Chiropractor
  • Terre Haute, IN
  • NPI 1427168517
  Medicare reassignment NPD Authorized official

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 10, 2009.

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247184000000",
    "number": "1003003534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 S 25TH STREET",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "47803",
            "telephone_number": "812-232-8803",
            "fax_number": "812-232-1305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 S 25TH STREET",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "47803",
            "telephone_number": "812-232-8803",
            "fax_number": "812-232-1305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHERIDGE CHIROPRACTIC CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-28",
        "last_updated": "2009-07-10",
        "deactivation_date": "2008-01-09",
        "reactivation_date": "2009-07-10",
        "status": "A",
        "authorized_official_last_name": "ETHERIDGE",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "812-232-8803",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08001352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100252800A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL OTHER MAJOR MED",
            "identifier": "08001352",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "598223Z",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000093143",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peggy Sue Escobedo, MS
• Danielle Eslick, OD
• Travis Essex
• Amanda Estes
• Alfonso Q Estrada, M.D.
• Eugene Wesley Etheridge Jr., DC
• Tiffany Marie Ethridge
• Anthony Eti-Ukwu, RPH
• Abigail M Etters, DO
• Janice Fajardo Evangelista, OTR

• All providers in Terre Haute, IN
• Chiropractor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.