Provider Demographics
NPI:1184295560
Name:HOUCHIN, TODD C
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:C
Last Name:HOUCHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11261 W SUDER LN
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47108-6505
Mailing Address - Country:US
Mailing Address - Phone:181-262-0877
Mailing Address - Fax:
Practice Address - Street 1:4106 REAS LN
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-3279
Practice Address - Country:US
Practice Address - Phone:812-528-0845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program