Provider Demographics
NPI:1083689863
Name:DONATELLO, JEFFREY GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GEORGE
Last Name:DONATELLO
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 416
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-0416
Mailing Address - Country:US
Mailing Address - Phone:207-438-9339
Mailing Address - Fax:207-438-9009
Practice Address - Street 1:76 US ROUTE 1 BY-PASS
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904
Practice Address - Country:US
Practice Address - Phone:207-438-9339
Practice Address - Fax:207-438-9009
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME017993OtherANTHEM ME PROVIDER ID
NH0500359Y0ME01OtherANTHEM NH PROVIDER ID
ME1041352OtherAETNA PROVIDER ID
MEMN0004OtherHPHC PROVIDER ID
ME2050690001OtherCIGNA PROVIDER ID
ME017993OtherANTHEM ME PROVIDER ID
ME2050690001OtherCIGNA PROVIDER ID