Provider Demographics
NPI:1588670681
Name:DEFAYETTE, TODD MICHAEL (DC)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:MICHAEL
Last Name:DEFAYETTE
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 1:834 DUANESBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-1021
Mailing Address - Country:US
Mailing Address - Phone:518-982-1492
Mailing Address - Fax:518-982-1494
Practice Address - Street 1:834 DUANESBURG RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-1021
Practice Address - Country:US
Practice Address - Phone:518-982-1492
Practice Address - Fax:518-982-1494
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10075808OtherCDPHP
43-2093041OtherTAX ID
NYC08804-9OtherWORKERS COMPENSATION
NY10075808OtherCDPHP