Provider Demographics
NPI:1972635787
Name:ODNOHA, JOSEPH GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GEORGE
Last Name:ODNOHA
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 1:42 FLAGLAR DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1315
Mailing Address - Country:US
Mailing Address - Phone:518-561-5165
Mailing Address - Fax:
Practice Address - Street 1:158 BOYNTON AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1278
Practice Address - Country:US
Practice Address - Phone:518-561-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56687BMedicare ID - Type Unspecified