Provider Demographics
NPI:1720256589
Name:TODD, TAMBRA JEAN (D C)
Entity Type:Individual
Prefix:DR
First Name:TAMBRA
Middle Name:JEAN
Last Name:TODD
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-1043
Mailing Address - Country:US
Mailing Address - Phone:317-833-3364
Mailing Address - Fax:
Practice Address - Street 1:2424 LAKE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4219
Practice Address - Country:US
Practice Address - Phone:317-833-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002354AAAAAAAAAAAA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor