Basic Information
Provider Information | |||||||||
NPI: | 1437318698 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | AMY M. O'DONNELL,DABCO,LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 35 RIVER RD | ||||||||
Address2: |   | ||||||||
City: | COS COB | ||||||||
State: | CT | ||||||||
PostalCode: | 068072759 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2038632944 | ||||||||
FaxNumber: | 2038634538 | ||||||||
Practice Location | |||||||||
Address1: | 35 RIVER RD | ||||||||
Address2: |   | ||||||||
City: | COS COB | ||||||||
State: | CT | ||||||||
PostalCode: | 068072759 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2038632944 | ||||||||
FaxNumber: | 2038634538 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/03/2008 | ||||||||
LastUpdateDate: | 06/03/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | O'DONNELL | ||||||||
AuthorizedOfficialFirstName: | AMY | ||||||||
AuthorizedOfficialMiddleName: | M. | ||||||||
AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
AuthorizedOfficialTelephone: | 2038632944 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | DABCO | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NX0800X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Orthopedic |
No ID Information.