Provider Demographics
NPI:1326239245
Name:JONATHAN L DONNER DC PC
Entity Type:Organization
Organization Name:JONATHAN L DONNER DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DONNER
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:585-223-1580
Mailing Address - Street 1:6605 PITTSFORD PALMYRA RD
Mailing Address - Street 2:SUITE E9
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3407
Mailing Address - Country:US
Mailing Address - Phone:585-223-1580
Mailing Address - Fax:
Practice Address - Street 1:6605 PITTSFORD PALMYRA RD
Practice Address - Street 2:SUITE E9
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3407
Practice Address - Country:US
Practice Address - Phone:585-223-1580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1191Medicare PIN