Healthcare Provider Details

I. General information

NPI: 1518572452
Provider Name (Legal Business Name): JORDAN ODLE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N SCOTTSDALE RD STE C
SCOTTSDALE AZ
85257-2145
US

IV. Provider business mailing address

6030 N 15TH ST UNIT 19
PHOENIX AZ
85014-2433
US

V. Phone/Fax

Practice location:
  • Phone: 805-443-4592
  • Fax:
Mailing address:
  • Phone: 805-443-4592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number8952
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number8952
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8952
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: