Individual
DR. EUGENE WESLEY ETHERIDGE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
631 SOUTH 25TH STREET, TERRE HAUTE, IN 47803
(812) 232-8803
(812) 232-8803
Mailing address
620 WOODBINE, TERRE HAUTE, IN 47803
(812) 877-0070
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001352
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000093143
ANTHEM BLUE CROSS BLUE SH
IN
01
—
08001352
ALL OTHERS
IN
01
—
5982232
AETNA
IN
Enumeration date
08/30/2006
Last updated
11/08/2007
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