Provider Demographics
NPI:1982696001
Name:ABERNATHY, TODD FULTON (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:FULTON
Last Name:ABERNATHY
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 1:612 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2312
Mailing Address - Country:US
Mailing Address - Phone:704-664-3455
Mailing Address - Fax:704-664-2827
Practice Address - Street 1:612 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2312
Practice Address - Country:US
Practice Address - Phone:704-664-3455
Practice Address - Fax:704-664-2827
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2947111N00000X
NC3737111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4881OtherPARTNERS MED GROUP
NC085A6OtherBCBS
NC43954OtherPARTNERS INDIVIDUAL
NC208640OtherQUALCHOICE
NC5909823002OtherCIGNA PAL
NC617420OtherACN
NC7741266OtherAETNA
NC0194LOtherBCBSNC (CNC)
NC2125041OtherUNITED HEALTHCARE
NC53164OtherAWHN
NC350053151OtherRAILROAD MEDICARE
NC89085A6Medicaid
NC53164OtherAWHN
NC0194LOtherBCBSNC (CNC)
NC617420OtherACN