Provider Demographics
NPI:1477673689
Name:MEXICO, TODD G (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:G
Last Name:MEXICO
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 1:630 BALDWINVILLE ROAD.
Mailing Address - Street 2:
Mailing Address - City:BALDWINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01436
Mailing Address - Country:US
Mailing Address - Phone:978-939-8700
Mailing Address - Fax:978-939-8786
Practice Address - Street 1:630 BALDWINVILLE ROAD.
Practice Address - Street 2:
Practice Address - City:BALDWINVILLE
Practice Address - State:MA
Practice Address - Zip Code:01436
Practice Address - Country:US
Practice Address - Phone:978-939-8700
Practice Address - Fax:978-939-8786
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA457312OtherTUFTS HEALTH PLAN
MAAA92111OtherHARVARD PILGRIM
MAY37160OtherBCBS OF MA
MA000024701Medicare PIN
MAAA92111OtherHARVARD PILGRIM