Provider Demographics
NPI:1093934507
Name:TODD, MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:TODD
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 1:322 NW 5TH AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3825
Mailing Address - Country:US
Mailing Address - Phone:207-370-8516
Mailing Address - Fax:503-616-7622
Practice Address - Street 1:322 NW 5TH AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3825
Practice Address - Country:US
Practice Address - Phone:207-370-8516
Practice Address - Fax:503-616-7622
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR713719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor