Provider Demographics
NPI:1093700270
Name:PORTER, TODD LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:LEE
Last Name:PORTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TODD
Other - Middle Name:LEE
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:721 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4044
Mailing Address - Country:US
Mailing Address - Phone:940-387-0405
Mailing Address - Fax:844-704-9562
Practice Address - Street 1:721 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4044
Practice Address - Country:US
Practice Address - Phone:940-387-0405
Practice Address - Fax:940-383-2966
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088460301Medicaid
TX088460301Medicaid
604079Medicare ID - Type Unspecified