Provider Demographics
NPI:1841255387
Name:STAFFORD, TODD DARIN (DC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:DARIN
Last Name:STAFFORD
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 1:3939 W RIDGE RD STE A-205
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1879
Mailing Address - Country:US
Mailing Address - Phone:814-838-8877
Mailing Address - Fax:814-838-4568
Practice Address - Street 1:3939 W RIDGE RD STE A-205
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1879
Practice Address - Country:US
Practice Address - Phone:814-838-8877
Practice Address - Fax:814-838-4568
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005023L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ST120803Medicare ID - Type Unspecified
U16535Medicare UPIN