Provider Demographics
NPI:1144381369
Name:ODEKIRK, TODD LEE (DC)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:LEE
Last Name:ODEKIRK
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 1:446 MEADOW STATION CIR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-4449
Mailing Address - Country:US
Mailing Address - Phone:720-842-0772
Mailing Address - Fax:720-842-0773
Practice Address - Street 1:7030 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2026
Practice Address - Country:US
Practice Address - Phone:303-721-9984
Practice Address - Fax:303-996-0433
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841531327OtherPRIMARY OFFICETAX ID
CO841531327OtherPRIMARY OFFICETAX ID
CO807651Medicare PIN
CO841519998OtherEIN