Active NPI
Charles Lloyd Odea, D.C.
- Chiropractor
- Suffolk, VA
National Provider Identifier
1053374090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 0104000247
- Practice address
- 817 Garden LN
Suffolk, VA 23434-2903 - Phone
- (757) 339-4422
- NPI assigned
- Apr 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 0104000247 | VA | Primary |
Addresses
Primary practice location
817 Garden LN
Suffolk, VA 23434-2903
Mailing address
817 Garden LN
Suffolk, VA 23434-2903
Phone (757) 339-4422
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110516000591 | VA | Practitioner - Chiropractic | 6305022971 | Practice locations: Suffolk, VA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606176000000",
"number": "1053374090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "817 GARDEN LN",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "234342903",
"telephone_number": "757-339-4422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "817 GARDEN LN",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "234342903",
"telephone_number": "757-339-4422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODEA",
"first_name": "CHARLES",
"middle_name": "LLOYD",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-10",
"last_updated": "2020-11-24",
"certification_date": "2020-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "VA",
"license": "0104000247",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suffolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.