Provider Demographics
NPI:1467623678
Name:TODD, MICHAEL WESLEY SR (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WESLEY
Last Name:TODD
Suffix:SR
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 1:366 STONE SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721-3012
Mailing Address - Country:US
Mailing Address - Phone:718-924-8607
Mailing Address - Fax:
Practice Address - Street 1:1711 SHEEPSHEAD BAY RD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3651
Practice Address - Country:US
Practice Address - Phone:718-513-3324
Practice Address - Fax:718-513-3325
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor