Healthcare Provider Details

I. General information

NPI: 1295853513
Provider Name (Legal Business Name): JAMES PAUL ODELL OMD, L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LYNDON LN
LOUISVILLE KY
40222-4603
US

IV. Provider business mailing address

305 LYNDON LN
LOUISVILLE KY
40222-4603
US

V. Phone/Fax

Practice location:
  • Phone: 502-429-8835
  • Fax:
Mailing address:
  • Phone: 502-429-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1199
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberKY13
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: