Provider Demographics
NPI:1861452922
Name:MCDONNELL, MATTHEW THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:MCDONNELL
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 1:913 POST RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-4114
Mailing Address - Country:US
Mailing Address - Phone:207-641-2225
Mailing Address - Fax:207-641-2226
Practice Address - Street 1:913 POST RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-4114
Practice Address - Country:US
Practice Address - Phone:207-641-2225
Practice Address - Fax:207-641-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME409100000Medicaid
ME409100000Medicaid
U79457Medicare UPIN