Provider Demographics
NPI:1164687398
Name:O'DELL, DAVID M (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:O'DELL
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 1:2187 LEXINGTON RD
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7919
Mailing Address - Country:US
Mailing Address - Phone:859-624-9699
Mailing Address - Fax:859-624-2699
Practice Address - Street 1:2187 LEXINGTON RD
Practice Address - Street 2:SUITE A-4
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7919
Practice Address - Country:US
Practice Address - Phone:859-624-9699
Practice Address - Fax:859-624-2699
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001760111N00000X
KY5284111N00000X
KY5284-KY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100169940Medicaid
KY7100169940Medicaid
K002420Medicare PIN