Provider Demographics
NPI:1124036991
Name:CROSS, DONNIE MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:DONNIE
Middle Name:MARTIN
Last Name:CROSS
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 1:500 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-1660
Mailing Address - Country:US
Mailing Address - Phone:850-627-1005
Mailing Address - Fax:
Practice Address - Street 1:1102 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2212
Practice Address - Country:US
Practice Address - Phone:850-875-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 0007109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH 0007109OtherLICENSE-STATE BOARD CHIR
FLCH 0007109OtherLICENSE-STATE BOARD CHIR