Provider Demographics
NPI:1669724795
Name:MDTD, LLC
Entity type:Organization
Organization Name:MDTD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-723-1880
Mailing Address - Street 1:26250 EUCLID AVE
Mailing Address - Street 2:SUITE 771
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26250 EUCLID AVE
Practice Address - Street 2:SUITE 771
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3305
Practice Address - Country:US
Practice Address - Phone:330-697-6833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-13
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC3000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty