Provider Demographics
NPI:1558333054
Name:TODD, JAMES L (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:TODD
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 1:312 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1636
Mailing Address - Country:US
Mailing Address - Phone:765-932-4234
Mailing Address - Fax:765-932-1234
Practice Address - Street 1:312 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1636
Practice Address - Country:US
Practice Address - Phone:765-932-4234
Practice Address - Fax:765-932-1234
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000087826OtherANTHEM BLUE CROSS/BLUE SH
IN100216170AMedicaid
INT88596Medicare UPIN
IN000000087826OtherANTHEM BLUE CROSS/BLUE SH