Provider Demographics
NPI:1316037294
Name:MUNYAT-DONNELLY, KELLY J (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:MUNYAT-DONNELLY
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 1:1660 ANDERSON HWY
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-8007
Mailing Address - Country:US
Mailing Address - Phone:804-897-3478
Mailing Address - Fax:
Practice Address - Street 1:1660 ANDERSON HWY
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-8007
Practice Address - Country:US
Practice Address - Phone:804-897-3478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU86455Medicare UPIN