Provider Demographics
NPI:1992713101
Name:CLANAHAN, TODD H (DC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:H
Last Name:CLANAHAN
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 1:105 N PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3932
Mailing Address - Country:US
Mailing Address - Phone:309-353-3300
Mailing Address - Fax:309-353-7961
Practice Address - Street 1:105 N PARKWAY DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3932
Practice Address - Country:US
Practice Address - Phone:309-353-3300
Practice Address - Fax:309-353-7961
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09022697OtherBLUE CROSS BLUE SHIELD
IL3500559154OtherRAILROAD MEDICARE
IL09022697OtherBLUE CROSS BLUE SHIELD
ILU74883Medicare UPIN