Provider Demographics
NPI:1366443426
Name:ULERY, TODD ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALLEN
Last Name:ULERY
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 1:109 CROSSROADS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-2458
Mailing Address - Country:US
Mailing Address - Phone:724-887-4661
Mailing Address - Fax:724-887-3329
Practice Address - Street 1:109 CROSSROADS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-2458
Practice Address - Country:US
Practice Address - Phone:724-887-4661
Practice Address - Fax:724-887-3329
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005213L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013931630001Medicaid
PA0013931630001Medicaid
PA438713Medicare ID - Type Unspecified