Provider Demographics
NPI:1811000557
Name:O'DELL, BEN A II (DC)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:A
Last Name:O'DELL
Suffix:II
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:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:NIOTA
Mailing Address - State:IL
Mailing Address - Zip Code:62358-0134
Mailing Address - Country:US
Mailing Address - Phone:217-448-4136
Mailing Address - Fax:
Practice Address - Street 1:308 ARBOR ST
Practice Address - Street 2:
Practice Address - City:NIOTA
Practice Address - State:IL
Practice Address - Zip Code:62358-1009
Practice Address - Country:US
Practice Address - Phone:217-448-4136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03425862OtherBC/BS
ILU78272Medicare UPIN
IL03425862OtherBC/BS