Individual
DR. RANDOLPH CLAY O'DELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1183 PONTIAC TRAIL, WALLED LAKE, MI 48390
(248) 624-6111
(248) 624-6129
Mailing address
1183 PONTIAC TRAIL, WALLED LAKE, MI 48390
(248) 624-6111
(248) 624-6129
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301002842
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1279839
—
MI
01
—
142073
AETNA INSURANCE
MI
Enumeration date
09/27/2006
Last updated
07/09/2007
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