Provider Demographics
NPI:1740364900
Name:ORCHARD, TODD ALVIN (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALVIN
Last Name:ORCHARD
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:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-0456
Mailing Address - Country:US
Mailing Address - Phone:208-656-8883
Mailing Address - Fax:208-656-8883
Practice Address - Street 1:160 EAST VALLEY RIVER DR STE 3
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440
Practice Address - Country:US
Practice Address - Phone:208-656-8883
Practice Address - Fax:208-656-8883
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010139170OtherREGENCE BLUE SHIELD OF ID
ID806386200Medicaid
IDC9905OtherBLUE CROSS
IDU91785Medicare UPIN
ID000010139170OtherREGENCE BLUE SHIELD OF ID