Provider Demographics
NPI:1992007538
Name:SEIDL, TODD CALVIN (DC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:CALVIN
Last Name:SEIDL
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 1:40 BIRCH AVE S
Mailing Address - Street 2:PO BOX 400
Mailing Address - City:MAPLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55358-4568
Mailing Address - Country:US
Mailing Address - Phone:320-296-9014
Mailing Address - Fax:
Practice Address - Street 1:40 BIRCH AVE S
Practice Address - Street 2:
Practice Address - City:MAPLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55358-4568
Practice Address - Country:US
Practice Address - Phone:320-296-9014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor