Provider Demographics
NPI:1063631059
Name:DONNELLY, CHRISTOPHER M (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:DONNELLY
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 1:1807 S WASHINGTON ST
Mailing Address - Street 2:STE 118
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2446
Mailing Address - Country:US
Mailing Address - Phone:630-428-4019
Mailing Address - Fax:
Practice Address - Street 1:1807 S WASHINGTON ST
Practice Address - Street 2:STE 118
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2446
Practice Address - Country:US
Practice Address - Phone:630-428-4019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU91436Medicare UPIN