Provider Demographics
NPI:1396964243
Name:TODD, DOUG WAYNE I (DC)
Entity type:Individual
Prefix:DR
First Name:DOUG
Middle Name:WAYNE
Last Name:TODD
Suffix:I
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 1:729 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5613
Mailing Address - Country:US
Mailing Address - Phone:580-332-4447
Mailing Address - Fax:580-332-4447
Practice Address - Street 1:729 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5613
Practice Address - Country:US
Practice Address - Phone:580-332-4447
Practice Address - Fax:580-332-4447
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor