Provider Demographics
NPI:1154440683
Name:LARGE, TODD H (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:H
Last Name:LARGE
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 1:173 CLINTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:PA
Mailing Address - Zip Code:15026-1928
Mailing Address - Country:US
Mailing Address - Phone:724-630-3712
Mailing Address - Fax:
Practice Address - Street 1:3572 BRODHEAD RD
Practice Address - Street 2:STE 302
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3141
Practice Address - Country:US
Practice Address - Phone:724-630-3712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA076501Medicare ID - Type Unspecified
PAU98689Medicare UPIN