Provider Demographics
NPI:1629006366
Name:JORGENSON, TODD A (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:JORGENSON
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 1:8888 JEFFERSON HWY STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2421
Mailing Address - Country:US
Mailing Address - Phone:225-928-3244
Mailing Address - Fax:225-928-3246
Practice Address - Street 1:8888 JEFFERSON HWY STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2421
Practice Address - Country:US
Practice Address - Phone:225-928-3244
Practice Address - Fax:225-928-3246
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DF30Medicare PIN
LAU89588Medicare UPIN