Provider Demographics
NPI:1801881537
Name:FLOM, TODD A (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:FLOM
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 1:1218 TUGGLE PKWY
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-7500
Mailing Address - Country:US
Mailing Address - Phone:715-483-3080
Mailing Address - Fax:715-483-3080
Practice Address - Street 1:1218 TUGGLE PKWY
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-7500
Practice Address - Country:US
Practice Address - Phone:715-483-3080
Practice Address - Fax:715-483-3080
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3924-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38944400Medicaid
WI000035499Medicare ID - Type Unspecified
WIU94652Medicare UPIN
WI559S4FLOtherMINNESOTA BC/BS