Provider Demographics
NPI:1053640730
Name:MCDONNEL LLC
Entity Type:Organization
Organization Name:MCDONNEL LLC
Other - Org Name:CAROLINE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDONNEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-448-0887
Mailing Address - Street 1:17470 CENTER DR
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:RUTHER GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22546-2881
Mailing Address - Country:US
Mailing Address - Phone:804-448-0887
Mailing Address - Fax:804-448-0887
Practice Address - Street 1:17470 CENTER DR
Practice Address - Street 2:SUITE 4C
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-2881
Practice Address - Country:US
Practice Address - Phone:804-448-0887
Practice Address - Fax:804-448-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty