Provider Demographics
NPI:1225096043
Name:ODUM, NEADUM BRETT (DC)
Entity Type:Individual
Prefix:
First Name:NEADUM
Middle Name:BRETT
Last Name:ODUM
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 1:15100 TRADITIONS BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1184
Mailing Address - Country:US
Mailing Address - Phone:405-509-6483
Mailing Address - Fax:405-513-6428
Practice Address - Street 1:15100 TRADITIONS BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1184
Practice Address - Country:US
Practice Address - Phone:405-509-6483
Practice Address - Fax:405-513-6428
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor