Healthcare Provider Details

I. General information

NPI: 1962599811
Provider Name (Legal Business Name): NICHOLAS ODETTE D.C., P.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8718 SWAN CREEK RD
NEWPORT MI
48166-9273
US

IV. Provider business mailing address

PO BOX 120
NEWPORT MI
48166-0120
US

V. Phone/Fax

Practice location:
  • Phone: 734-586-0293
  • Fax: 734-586-0295
Mailing address:
  • Phone: 734-586-0293
  • Fax: 734-586-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008690
License Number StateMI

VIII. Authorized Official

Name: DR. NICHOLAS JOHN ODETTE
Title or Position: OWNER
Credential: D.C.
Phone: 734-586-0293