Provider Demographics
NPI:1659601177
Name:O'DONNELL, WILLIAM JOSEPH JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:O'DONNELL
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 1:107 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4715
Mailing Address - Country:US
Mailing Address - Phone:541-363-3100
Mailing Address - Fax:866-572-0412
Practice Address - Street 1:107 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4715
Practice Address - Country:US
Practice Address - Phone:541-363-3100
Practice Address - Fax:866-572-0412
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92461Medicare UPIN