Provider Demographics
NPI:1073616496
Name:DONAGHE, BRIAN L (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:L
Last Name:DONAGHE
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:PO BOX 256
Mailing Address - Street 2:399 MAIN ST STE 1
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465
Mailing Address - Country:US
Mailing Address - Phone:805-434-2300
Mailing Address - Fax:805-434-9748
Practice Address - Street 1:399 MAIN ST
Practice Address - Street 2:STE 1
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465
Practice Address - Country:US
Practice Address - Phone:805-434-2300
Practice Address - Fax:805-434-9748
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U70944Medicare UPIN
DC20572Medicare ID - Type Unspecified