Provider Demographics
NPI:1174634679
Name:RICHARDSON, TODD ALAN (DCPA)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ALAN
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:708 ASH BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8871
Mailing Address - Country:US
Mailing Address - Phone:302-449-0149
Mailing Address - Fax:302-449-2041
Practice Address - Street 1:726 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-3009
Practice Address - Country:US
Practice Address - Phone:302-427-2990
Practice Address - Fax:302-427-2994
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE672004OtherACN GROUP
DE510405275OtherBLUE CROSS BLUE SHEILD
DE349080OtherAMERIHEALTH
DE7098137OtherAETNA LIFE
DE0056669000OtherAMERIHEALTH HMO
DE1000036285Medicaid
DE2882144OtherAETNA
DE2102080OtherOPTIMUM CHOICE
DE2102080OtherALLIANCE PPO
DE2102080OtherMAMSI
DE326083OtherCOVENTRY
DE2102080OtherALLIANCE PPO
DEV03346Medicare UPIN