Provider Demographics
NPI:1689842486
Name:AQUIDNECK CHIROPRACTIC
Entity Type:Organization
Organization Name:AQUIDNECK CHIROPRACTIC
Other - Org Name:DR. CHARLES K. DONOVAN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-849-7011
Mailing Address - Street 1:1272 WEST MAIN RD
Mailing Address - Street 2:THE GREEN, BUILDING 2
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-849-7011
Mailing Address - Fax:401-847-1449
Practice Address - Street 1:1272 W MAIN RD
Practice Address - Street 2:THE GREEN, BUILDING 2
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6335
Practice Address - Country:US
Practice Address - Phone:401-849-7011
Practice Address - Fax:401-847-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIT53501Medicare UPIN