Provider Demographics
NPI:1639287832
Name:ODETTE, PATRICIA A (DC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:ODETTE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20960 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1018
Mailing Address - Country:US
Mailing Address - Phone:734-479-5130
Mailing Address - Fax:734-479-4678
Practice Address - Street 1:20960 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1018
Practice Address - Country:US
Practice Address - Phone:734-479-5130
Practice Address - Fax:734-479-4678
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPO004287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q25025Medicare ID - Type Unspecified
MIT33819Medicare UPIN