Provider Demographics
NPI:1669529962
Name:O'DONNELL, STEVEN JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 N COLONY RD
Mailing Address - Street 2:#3005
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-1900
Mailing Address - Country:US
Mailing Address - Phone:203-235-0171
Mailing Address - Fax:203-235-3310
Practice Address - Street 1:74 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6545
Practice Address - Country:US
Practice Address - Phone:203-235-0171
Practice Address - Fax:203-235-3310
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000854111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT91360Medicare UPIN
CT350001344Medicare ID - Type Unspecified