Provider Demographics
NPI:1174664197
Name:STEIN, TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:STEIN
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 1:2343 N TRIPHAMMER RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1092
Mailing Address - Country:US
Mailing Address - Phone:607-266-4325
Mailing Address - Fax:607-266-7482
Practice Address - Street 1:2343 N TRIPHAMMER RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1092
Practice Address - Country:US
Practice Address - Phone:607-266-4325
Practice Address - Fax:607-266-7482
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-007859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000012282OtherBLUE CROSS-BLUE SHIELD ID
NY56764BMedicare ID - Type Unspecified