MEDICARE: NICHOLAS ODETTE D.C., P.L.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	2301008690	MI

General Provider Information

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

Provider Business Mailing Address
First Line	:	PO BOX 120
Second Line	:
City	:	NEWPORT
State	:	MI
Zip	:	48166-0120
Country	:	US
Telephone Number	:	734-586-0293
Fax Number	:	734-586-0295

Provider Business Practice Location Address
First Line	:	8718 SWAN CREEK RD
Second Line	:
City	:	NEWPORT
State	:	MI
Zip	:	48166-9273
Country	:	US
Telephone Number	:	734-586-0293
Fax Number	:	734-586-0295

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICHOLAS JOHN ODETTE
Credential	:	D.C.
Telephone Number	:	734-586-0293

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	12/06/2025

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