Provider Demographics
NPI:1407922578
Name:DONATO, VINCENT J (DC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:J
Last Name:DONATO
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 1:11340 OLYMPIC BLVD
Mailing Address - Street 2:#335
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064
Mailing Address - Country:US
Mailing Address - Phone:310-446-1829
Mailing Address - Fax:310-445-0051
Practice Address - Street 1:11340 OLYMPIC BLVD
Practice Address - Street 2:#335
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064
Practice Address - Country:US
Practice Address - Phone:310-446-1829
Practice Address - Fax:310-445-0051
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19760Medicare ID - Type Unspecified