Provider Demographics
NPI:1013018282
Name:PICKMAN, TODD STEVEN (DC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:STEVEN
Last Name:PICKMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 E MAGIC VIEW DR STE 180
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3745
Mailing Address - Country:US
Mailing Address - Phone:208-888-6077
Mailing Address - Fax:888-447-1415
Practice Address - Street 1:3085 E MAGIC VIEW DR. SUITE 180
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-888-6077
Practice Address - Fax:888-447-1415
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1516111N00000X
NM1588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor