Provider Demographics
NPI:1376676361
Name:FODOR, TROY EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:EDWARD
Last Name:FODOR
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 1:1724 WESLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-6001
Mailing Address - Country:US
Mailing Address - Phone:509-839-5656
Mailing Address - Fax:509-839-5682
Practice Address - Street 1:1724 WESLEY WAY
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-6001
Practice Address - Country:US
Practice Address - Phone:509-839-8000
Practice Address - Fax:509-515-2814
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000119649OtherMEDICARE RAILROAD
WAFO1686OtherREGENCE
WA75565OtherLI
WAFO1686OtherREGENCE
29303Medicare UPIN