Provider Demographics
NPI:1700106499
Name:O'DONNELL, DANIEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
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 1:514 N CORNWALL AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-1356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1907 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1545
Practice Address - Country:US
Practice Address - Phone:609-569-1040
Practice Address - Fax:609-241-0041
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00693400111N00000X
PADC010433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor