Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | L766087 | MI |
Y | 111NN0400X | Neurology | 3661 | SC |
NPI | 1992821078 |
---|---|
Provider Name | Dr. Todd Overdorf |
First Address | Mt. Pleasant, SC 29464 |
Second Address | Mount Pleasant, SC 29464-9998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 29/09/2011 |