Provider Demographics
NPI:1104390343
Name:DONOHOE, GRADY (DC)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:
Last Name:DONOHOE
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 1:5115 S PEACH WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-2715
Mailing Address - Country:US
Mailing Address - Phone:308-627-5583
Mailing Address - Fax:
Practice Address - Street 1:1914 S POWER RD STE 107
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4376
Practice Address - Country:US
Practice Address - Phone:308-627-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018045551111N00000X
NE1994111N00000X
AZ9030111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111N00000XChiropractic ProvidersChiropractor