Healthcare Provider Details

I. General information

NPI: 1265419782
Provider Name (Legal Business Name): TODD A HOAGLAND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 EAST MAIN ST.
ROBINSON IL
62454
US

IV. Provider business mailing address

2135 EAST MAIN ST.
ROBINSON IL
62454
US

V. Phone/Fax

Practice location:
  • Phone: 618-544-2064
  • Fax: 618-544-9028
Mailing address:
  • Phone: 618-544-2064
  • Fax: 618-544-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: