Basic Information
| Provider Information | |||||||||
| NPI: | 1043396773 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACDOWALL | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 ANNJO CT | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245512631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344552484 | ||||||||
| FaxNumber: | 4344552486 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 ANNJO COURT | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344552484 | ||||||||
| FaxNumber: | 4344552486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 08/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 0104001115 | VA | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 409364 | 01 | VA | SOUTHERN HEALTH | OTHER | 038496 | 01 | VA | ANTHEM BCBS | OTHER |