Provider Demographics
NPI:1194855775
Name:TODD, HARRISON RODGERS II (DC)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:RODGERS
Last Name:TODD
Suffix:II
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 1:1703 24TH STREET
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:37960-3351
Mailing Address - Country:US
Mailing Address - Phone:772-562-2053
Mailing Address - Fax:772-562-8197
Practice Address - Street 1:1703 24TH STREET
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:37960-3351
Practice Address - Country:US
Practice Address - Phone:772-562-2053
Practice Address - Fax:772-562-8197
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22212OtherBLUECROSS BLUESHIELD FL
T86298Medicare UPIN
FL22212YMedicare PIN