Provider Demographics
NPI:1720689359
Name:TODD, ANDREW L (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:TODD
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 1:11223 W 64TH TER APT 501
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-3374
Mailing Address - Country:US
Mailing Address - Phone:785-294-0214
Mailing Address - Fax:
Practice Address - Street 1:8550 MARSHALL DR STE 105
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1505
Practice Address - Country:US
Practice Address - Phone:913-888-4845
Practice Address - Fax:913-888-9248
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty