Provider Demographics
NPI:1043396773
Name:MACDOWALL, TODD MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MARK
Last Name:MACDOWALL
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 1:103 ANNJO CT
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2631
Mailing Address - Country:US
Mailing Address - Phone:434-455-2484
Mailing Address - Fax:434-455-2486
Practice Address - Street 1:103 ANNJO COURT
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551
Practice Address - Country:US
Practice Address - Phone:434-455-2484
Practice Address - Fax:434-455-2486
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA409364OtherSOUTHERN HEALTH
VA038496OtherANTHEM BCBS
VA038496OtherANTHEM BCBS
VA409364OtherSOUTHERN HEALTH