Provider Demographics
NPI:1750573176
Name:COSSAR, TODD MACLIN (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:MACLIN
Last Name:COSSAR
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 941
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1416
Mailing Address - Country:US
Mailing Address - Phone:706-886-9616
Mailing Address - Fax:
Practice Address - Street 1:2766 GEORGIA HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-8777
Practice Address - Country:US
Practice Address - Phone:706-886-9616
Practice Address - Fax:706-282-0365
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5667111N00000X
TN1324111N00000X
NC2359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G350004OtherMEDICARE GROUP NUMBER
GA511I350016Medicare PIN