Provider Demographics
NPI:1235241423
Name:AUSTIN, TODD W (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:W
Last Name:AUSTIN
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 1:157 N SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:VIRDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62690-1455
Mailing Address - Country:US
Mailing Address - Phone:217-965-3100
Mailing Address - Fax:
Practice Address - Street 1:157 N SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:VIRDEN
Practice Address - State:IL
Practice Address - Zip Code:62690-1455
Practice Address - Country:US
Practice Address - Phone:217-965-3100
Practice Address - Fax:845-875-0531
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5930334OtherBC/BS
IL5930334OtherBC/BS
ILU43278Medicare UPIN