Provider Demographics
NPI:1992821078
Name:OVERDORF, TODD (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:OVERDORF
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 1:501 BRAMSON CT.
Mailing Address - Street 2:#200
Mailing Address - City:MT. PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 BRAMSON CT.
Practice Address - Street 2:#200
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9998
Practice Address - Country:US
Practice Address - Phone:616-403-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL766087111N00000X
SC3661111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor