Provider Demographics
NPI:1851483580
Name:JOHNSONBAUGH, TODD (DC)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:JOHNSONBAUGH
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 1:10520 CHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1315
Mailing Address - Country:US
Mailing Address - Phone:410-313-9608
Mailing Address - Fax:
Practice Address - Street 1:8600 SNOWDEN RIVER PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1982
Practice Address - Country:US
Practice Address - Phone:410-720-5555
Practice Address - Fax:410-381-4653
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD918L375EMedicare PIN