Provider Demographics
NPI:1659355352
Name:WORTHINGTON, TODD MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MATTHEW
Last Name:WORTHINGTON
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 1:55 TAHLEQUAH TRAIL
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-1154
Mailing Address - Country:US
Mailing Address - Phone:937-704-0714
Mailing Address - Fax:937-704-0715
Practice Address - Street 1:55 TAHLEQUAH TRAIL
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-1154
Practice Address - Country:US
Practice Address - Phone:937-704-0714
Practice Address - Fax:937-704-0715
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2228146Medicaid
W04025992Medicare ID - Type Unspecified
OH2228146Medicaid