Healthcare Provider Details

I. General information

NPI: 1356445084
Provider Name (Legal Business Name): TODD R BULLINGER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E KIRACOFE AVE
ELIDA OH
45807-1031
US

IV. Provider business mailing address

415 E KIRACOFE AVE
ELIDA OH
45807-1031
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-2639
  • Fax: 419-227-2640
Mailing address:
  • Phone: 419-227-2639
  • Fax: 419-227-2639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3680
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002237A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: