Active NPI
Carson Edward Odegard, D.C.
- Sports Physician Chiropractor
- Kirkland, WA
National Provider Identifier
1487607164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 1558
- Practice address
- 816 6TH St S
Kirkland, WA 98033-6714 - Phone
- (425) 827-4646
- Fax
- (425) 827-1941
- NPI assigned
- May 17, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | 1558 | WA | |
| Sports Physician Chiropractor | 111NS0005X | 1558 | WA | Primary |
Addresses
Primary practice location
816 6TH St S
Kirkland, WA 98033-6714
Mailing address
433 State St
Ste. #3
Kirkland, WA 98033
Phone (425) 827-4646
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010752001 | Other | WA | GROUP HEALTH |
| 95126 | Other | WA | LABOR & INDUSTRIES |
| OD-0076 | Other | WA | REGENCE |
| 391945651 | Other | WA | CIGNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1558 | WA | MD | Sports Physician Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511308800000",
"number": "1487607164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "433 STATE ST",
"address_2": "STE. #3",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "98033",
"telephone_number": "425-827-4646",
"fax_number": "425-827-1941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "816 6TH ST S",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980336714",
"telephone_number": "425-827-4646",
"fax_number": "425-827-1941"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODEGARD",
"first_name": "CARSON",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2017-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "302R00000X",
"taxonomy_group": "",
"desc": "Health Maintenance Organization",
"state": "WA",
"license": "1558",
"primary": false
},
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "WA",
"license": "1558",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP HEALTH",
"identifier": "010752001",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRIES",
"identifier": "95126",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "OD-0076",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "391945651",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kirkland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.