Provider Demographics
NPI:1356445084
Name:BULLINGER, TODD R (DC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:R
Last Name:BULLINGER
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 1:415 E KIRACOFE AVE
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-1031
Mailing Address - Country:US
Mailing Address - Phone:419-227-2639
Mailing Address - Fax:419-227-2639
Practice Address - Street 1:415 E KIRACOFE AVE
Practice Address - Street 2:
Practice Address - City:ELIDA
Practice Address - State:OH
Practice Address - Zip Code:45807-1031
Practice Address - Country:US
Practice Address - Phone:419-227-2639
Practice Address - Fax:419-227-2640
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3680111N00000X
IN08002237A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200811670Medicaid
OH2624897Medicaid
OH9312811OtherPTAN
OH9363471OtherPTAN
IN200811670Medicaid
OHP00323014Medicare PIN
OH9363471OtherPTAN
OH2624897Medicaid
IN221280EMedicare PIN
OH4176172Medicare PIN