Provider Demographics
NPI:1972678407
Name:KOUDELKA, TODD EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:EDWARD
Last Name:KOUDELKA
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 1:15200 SOUTHWEST FWY STE 295
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3865
Mailing Address - Country:US
Mailing Address - Phone:281-903-7008
Mailing Address - Fax:281-903-7877
Practice Address - Street 1:15200 SOUTHWEST FWY
Practice Address - Street 2:SUITE 295
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3845
Practice Address - Country:US
Practice Address - Phone:281-229-0612
Practice Address - Fax:281-412-4629
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10355111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation