Organization
ETHERIDGE CHIROPRACTIC CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE W ETHERIDGE JR. DC (DOCTOR)
(812) 232-8803
Entity
Organization
Contact information
Practice address
631 S 25TH STREET, TERRE HAUTE, IN 47803
(812) 232-8803
(812) 232-1305
Mailing address
631 S 25TH STREET, TERRE HAUTE, IN 47803
(812) 232-8803
(812) 232-1305
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001352
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000093143
ANTHEM BCBS
IN
01
—
08001352
ALL OTHER MAJOR MED
IN
05
—
100252800A
—
IN
01
—
598223Z
AETNA
IN
Enumeration date
09/28/2007
Last updated
07/10/2009
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