Provider Demographics
NPI:1811906845
Name:HILDEBRAND, TODD ADAM (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ADAM
Last Name:HILDEBRAND
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 1:1001 S 4J ROAD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716
Mailing Address - Country:US
Mailing Address - Phone:307-686-2327
Mailing Address - Fax:307-687-1106
Practice Address - Street 1:1001 4J ROAD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-0000
Practice Address - Country:US
Practice Address - Phone:307-686-2327
Practice Address - Fax:307-687-1106
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308120Medicare ID - Type Unspecified