Provider Demographics
NPI:1508380304
Name:TODD CHIROPRACTIC
Entity Type:Organization
Organization Name:TODD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:J
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-584-1352
Mailing Address - Street 1:1156 S STATE ST STE 106
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-8234
Mailing Address - Country:US
Mailing Address - Phone:801-225-5486
Mailing Address - Fax:
Practice Address - Street 1:1156 S STATE ST STE 106
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-8234
Practice Address - Country:US
Practice Address - Phone:801-225-5486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10234865-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty