Provider Demographics
NPI:1457062267
Name:O'DONNELL, STEVEN DMITRI (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DMITRI
Last Name:O'DONNELL
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 1:693 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4341
Mailing Address - Country:US
Mailing Address - Phone:203-440-9686
Mailing Address - Fax:
Practice Address - Street 1:693 BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4341
Practice Address - Country:US
Practice Address - Phone:203-440-9686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor