Provider Demographics
NPI:1710905427
Name:TODD CREIGHTON, DC, PA
Entity Type:Organization
Organization Name:TODD CREIGHTON, DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-599-1077
Mailing Address - Street 1:9540 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3667
Mailing Address - Country:US
Mailing Address - Phone:301-599-1077
Mailing Address - Fax:301-599-6692
Practice Address - Street 1:9540 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3667
Practice Address - Country:US
Practice Address - Phone:301-599-1077
Practice Address - Fax:301-599-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU60290Medicare UPIN
MD490764Medicare ID - Type Unspecified