Provider Demographics
NPI:1609898428
Name:ODONNELL, JOSEPH E JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:ODONNELL
Suffix:JR
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 1:2056 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-4033
Mailing Address - Country:US
Mailing Address - Phone:717-767-4101
Mailing Address - Fax:717-767-6353
Practice Address - Street 1:2056 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-4033
Practice Address - Country:US
Practice Address - Phone:717-767-4101
Practice Address - Fax:717-767-6353
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006337L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T73073Medicare UPIN
087582Medicare ID - Type Unspecified