Provider Demographics
NPI:1083718720
Name:EAST, TODD ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALLEN
Last Name:EAST
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 1:80 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-3403
Mailing Address - Country:US
Mailing Address - Phone:918-787-6700
Mailing Address - Fax:918-787-2846
Practice Address - Street 1:80 W 7TH ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-3403
Practice Address - Country:US
Practice Address - Phone:918-787-6700
Practice Address - Fax:918-787-2846
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00167123OtherRAILROAD MEDICARE
OK20051200AMedicaid
U62861Medicare UPIN
OK244503101Medicare ID - Type Unspecified