Provider Demographics
NPI:1093903049
Name:ANNA BONE ODOM, D.C.
Entity Type:Organization
Organization Name:ANNA BONE ODOM, D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:BONE
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-501-7552
Mailing Address - Street 1:7734 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5407
Mailing Address - Country:US
Mailing Address - Phone:314-961-1807
Mailing Address - Fax:
Practice Address - Street 1:7734 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5407
Practice Address - Country:US
Practice Address - Phone:314-961-1807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty