Provider Demographics
NPI:1760480115
Name:STRATTON, TODD DAVID (DC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:DAVID
Last Name:STRATTON
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 1:2555 S 11TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2174
Mailing Address - Country:US
Mailing Address - Phone:269-375-2488
Mailing Address - Fax:269-375-1788
Practice Address - Street 1:2555 S 11TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2174
Practice Address - Country:US
Practice Address - Phone:269-375-2488
Practice Address - Fax:269-375-1788
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C95050OtherBCBSM PROVIDER NUMBER
MIP52080002Medicare PIN
MIU77694Medicare UPIN