Provider Demographics
NPI:1396935516
Name:JAMES W O'DELL D.C. P.C.
Entity type:Organization
Organization Name:JAMES W O'DELL D.C. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:O'DELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC PC
Authorized Official - Phone:734-728-8100
Mailing Address - Street 1:1214 S WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4360
Mailing Address - Country:US
Mailing Address - Phone:734-728-8100
Mailing Address - Fax:734-728-7309
Practice Address - Street 1:1214 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4360
Practice Address - Country:US
Practice Address - Phone:734-728-8100
Practice Address - Fax:734-728-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H25228Medicare PIN