Provider Demographics
NPI:1780739722
Name:JARVIS, TODD M (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:M
Last Name:JARVIS
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 1:10833 BOYETTE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-8012
Mailing Address - Country:US
Mailing Address - Phone:813-741-0655
Mailing Address - Fax:813-741-0945
Practice Address - Street 1:10833 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-8012
Practice Address - Country:US
Practice Address - Phone:813-741-0655
Practice Address - Fax:813-741-0945
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55787Medicare ID - Type UnspecifiedPROVIDER NUMBER
FLU84176Medicare UPIN