Provider Demographics
NPI:1043379555
Name:KLEINSTEIN, TODD (DC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:KLEINSTEIN
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:PO BOX 1171
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-5171
Mailing Address - Country:US
Mailing Address - Phone:586-948-7246
Mailing Address - Fax:586-948-2748
Practice Address - Street 1:28039 CARRIAGE WAY DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2101
Practice Address - Country:US
Practice Address - Phone:586-948-7246
Practice Address - Fax:586-948-2748
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-3637723Medicare PIN
MI0N62880Medicare PIN