MEDICARE: DR. OGECHI ODITA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	10276	TX

General Provider Information

NPI Number	:	1861552861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OGECHI ODITA D.C.

Provider Business Mailing Address
First Line	:	9304 FOREST LN STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-6262
Country	:	US
Telephone Number	:	214-802-2458
Fax Number	:	972-279-0655

Provider Business Practice Location Address
First Line	:	9304 FOREST LN STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-6262
Country	:	US
Telephone Number	:	972-279-0644
Fax Number	:	972-279-0655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	06/17/2024

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