Provider Demographics
NPI:1790794188
Name:WRIGHT, TODD MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:WRIGHT
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 1:1203 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4011
Mailing Address - Country:US
Mailing Address - Phone:707-545-2105
Mailing Address - Fax:707-545-2107
Practice Address - Street 1:1203 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4011
Practice Address - Country:US
Practice Address - Phone:707-545-2105
Practice Address - Fax:707-545-2107
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0222140Medicare ID - Type Unspecified
CAU376293571725Medicare UPIN