Provider Demographics
NPI:1770717829
Name:PERSONETT, TODD ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANDREW
Last Name:PERSONETT
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 1:10801 JOHNSTON RD
Mailing Address - Street 2:STE 112
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7855
Mailing Address - Country:US
Mailing Address - Phone:610-389-9574
Mailing Address - Fax:704-504-0495
Practice Address - Street 1:10801 JOHNSTON RD
Practice Address - Street 2:STE 112
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-7855
Practice Address - Country:US
Practice Address - Phone:704-759-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3671111N00000X
PADC009175111N00000X
NYX011425-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor