Provider Demographics
NPI:1487798583
Name:TODD A. HANSCOM, DC, LLC
Entity type:Organization
Organization Name:TODD A. HANSCOM, DC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HANSCOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:229-226-3664
Mailing Address - Street 1:16820 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-7833
Mailing Address - Country:US
Mailing Address - Phone:229-226-3664
Mailing Address - Fax:229-226-9169
Practice Address - Street 1:16820 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-7833
Practice Address - Country:US
Practice Address - Phone:229-226-3664
Practice Address - Fax:229-226-9169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA08401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G701199OtherMEDICARE PTAN