Provider Demographics
NPI:1689733024
Name:FUNK, DONNA ESTY (DC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:ESTY
Last Name:FUNK
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 1:90 MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CENTERBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06409
Mailing Address - Country:US
Mailing Address - Phone:860-767-2119
Mailing Address - Fax:860-767-2836
Practice Address - Street 1:90 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CENTERBROOK
Practice Address - State:CT
Practice Address - Zip Code:06409
Practice Address - Country:US
Practice Address - Phone:860-767-2119
Practice Address - Fax:860-767-2836
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0500000484CT01OtherCONNECTICARE
0500000484CT01OtherCONNECTICARE