Provider Demographics
NPI:1841400280
Name:EDDY, DONNEL BERNARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DONNEL
Middle Name:BERNARD
Last Name:EDDY
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 1:104 MELBOURNE PARK CIR APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-3923
Mailing Address - Country:US
Mailing Address - Phone:434-977-9797
Mailing Address - Fax:
Practice Address - Street 1:104 MELBOURNE PARK CIR APT A
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-3923
Practice Address - Country:US
Practice Address - Phone:434-977-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009775111N00000X
VA0104557360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10082112OtherCDPHP PROVIDER NUMBER
NYX6T37OtherEMPIRE BC PROVIDER #
NYU69577Medicare UPIN
NYU69577Medicare UPIN