O'Dell, Randolph Clay
O'Dell, Randolph Clay is an sole proprietor health care provider with primary practice located at 1183 Pontiac Trail , Walled Lake MI 48390. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. O'Dell, Randolph Clay can be contacted via phone (248) 624-6111.Contact Information
Primary practice address
1183 Pontiac Trail
Walled Lake MI 48390
Phone: (248) 624-6111
Fax: (248) 624-6129
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 2301002842 | Michigan |
Profile Details
| NPI number | 1477644375 |
|---|---|
| LBN Legal business name | O'Dell, Randolph Clay |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 27th, 2006 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1477644375 | NPPES |
| Michigan | MEDICAID | 1279839 | |
| Michigan | Other | 142073 |
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