Provider Demographics
NPI:1437246246
Name:NODINE, DONALD LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEE
Last Name:NODINE
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 1:621 FARMINGTON AVENUE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-236-1752
Mailing Address - Fax:860-236-0703
Practice Address - Street 1:621 FARMINGTON AVENUE
Practice Address - Street 2:SUITE 105
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-236-1752
Practice Address - Fax:860-236-0703
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor