Provider Demographics
NPI: | 1710437942 |
---|---|
Name: | DONAHUE CHIROPRACTIC LLC |
Entity Type: | Organization |
Organization Name: | DONAHUE CHIROPRACTIC LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DOCTOR OF CHIROPRACTIC |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | BRENNAN |
Authorized Official - Middle Name: | DANIEL |
Authorized Official - Last Name: | DONAHUE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 314-553-9785 |
Mailing Address - Street 1: | 7225 WATSON RD |
Mailing Address - Street 2: | |
Mailing Address - City: | SAINT LOUIS |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 63119-4401 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 314-553-9785 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7225 WATSON RD |
Practice Address - Street 2: | |
Practice Address - City: | SAINT LOUIS |
Practice Address - State: | MO |
Practice Address - Zip Code: | 63119 |
Practice Address - Country: | US |
Practice Address - Phone: | 314-553-9785 |
Practice Address - Fax: | 314-553-9786 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-10-12 |
Last Update Date: | 2018-05-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | 2016033337 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |