Provider Demographics
NPI:1407973696
Name:CUMMINS, THEODORE J (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:J
Last Name:CUMMINS
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 1:154 S YOSEMITE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3957
Mailing Address - Country:US
Mailing Address - Phone:209-847-3071
Mailing Address - Fax:
Practice Address - Street 1:154 S YOSEMITE AVE STE C
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3957
Practice Address - Country:US
Practice Address - Phone:209-847-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28360111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0283600Medicare ID - Type Unspecified