Provider Demographics
NPI:1164650552
Name:CALLAWAY, DONNA RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:RENEE
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 W FLAMINGO RD STE 112A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6447
Mailing Address - Country:US
Mailing Address - Phone:702-932-6100
Mailing Address - Fax:702-932-6102
Practice Address - Street 1:9330 W FLAMINGO RD STE 112A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6447
Practice Address - Country:US
Practice Address - Phone:702-932-6100
Practice Address - Fax:702-932-6102
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1720415656OtherSERENITY SPINAL CARE, LLC NPI
NVV107102OtherMEDICARE PTAN