Healthcare Provider Details

I. General information

NPI: 1477673689
Provider Name (Legal Business Name): TODD G MEXICO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 BALDWINVILLE ROAD.
BALDWINVILLE MA
01436
US

IV. Provider business mailing address

630 BALDWINVILLE ROAD.
BALDWINVILLE MA
01436
US

V. Phone/Fax

Practice location:
  • Phone: 978-939-8700
  • Fax: 978-939-8786
Mailing address:
  • Phone: 978-939-8700
  • Fax: 978-939-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3124
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: