Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 8952 | AZ |
N | 111NN1001X | Nutrition | 8952 | AZ |
N | 111NS0005X | Chiropractic Sports Physician | 8952 | AZ |
NPI | 1518572452 |
---|---|
Provider Name | Dr. Jordan Odle |
First Address | Phoenix, AZ 85014-2433 |
Second Address | Scottsdale, AZ 85257-2145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2020 |
Last Update Date | 08/09/2020 |