Provider Demographics
NPI:1851465306
Name:O'DELL, ROBERT MILTON (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MILTON
Last Name:O'DELL
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 1:1809 CLIFF DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-1641
Mailing Address - Country:US
Mailing Address - Phone:805-963-2069
Mailing Address - Fax:805-965-6436
Practice Address - Street 1:1809 CLIFF DR
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-1641
Practice Address - Country:US
Practice Address - Phone:805-963-2069
Practice Address - Fax:805-965-6436
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17554Medicare UPIN
CADC13631Medicare ID - Type UnspecifiedPROIDER #