Provider Demographics
NPI:1043455736
Name:LEVINE, TODD MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MICHAEL
Last Name:LEVINE
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 1:3530 LONG BEACH RD APT 41
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5725
Mailing Address - Country:US
Mailing Address - Phone:917-701-4510
Mailing Address - Fax:
Practice Address - Street 1:1335 W TABOR RD
Practice Address - Street 2:SUITE 211
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3038
Practice Address - Country:US
Practice Address - Phone:917-701-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007704111N00000X
PADC005968L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor