Provider Demographics
NPI:1639162043
Name:DONOHUE, THOMAS P (DC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:P
Last Name:DONOHUE
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:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-0240
Mailing Address - Country:US
Mailing Address - Phone:715-532-6789
Mailing Address - Fax:
Practice Address - Street 1:804 W 9TH ST N
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1267
Practice Address - Country:US
Practice Address - Phone:715-532-6789
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1493-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
13318OtherSECURITY HEALTH
WI38758400Medicaid
WI38758400Medicaid