Provider Demographics
NPI:1669505194
Name:BLAN, TODD WELLINGTON (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:WELLINGTON
Last Name:BLAN
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 1:914 GUNTHER BLF
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-1609
Mailing Address - Country:US
Mailing Address - Phone:210-862-6882
Mailing Address - Fax:
Practice Address - Street 1:1202 E SONTERRA BLVD
Practice Address - Street 2:STE. 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4089
Practice Address - Country:US
Practice Address - Phone:210-862-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10901OtherCHIROPRACTIC LICENSE