Provider Demographics
NPI:1851838700
Name:DONNELL CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DONNELL CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-459-1339
Mailing Address - Street 1:2314 GULL RD
Mailing Address - Street 2:A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1432
Mailing Address - Country:US
Mailing Address - Phone:269-459-1339
Mailing Address - Fax:269-459-1340
Practice Address - Street 1:2314 GULL RD
Practice Address - Street 2:A
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1432
Practice Address - Country:US
Practice Address - Phone:269-459-1339
Practice Address - Fax:269-459-1340
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONNELL CHIROPRACTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty