Provider Demographics
NPI:1891976973
Name:DONOGHUE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DONOGHUE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:DONOGHUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:845-679-1253
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:WEST HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12491-0368
Mailing Address - Country:US
Mailing Address - Phone:845-679-1253
Mailing Address - Fax:845-679-3217
Practice Address - Street 1:1314 ROUTE 28
Practice Address - Street 2:
Practice Address - City:WEST HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12491-0368
Practice Address - Country:US
Practice Address - Phone:845-679-1253
Practice Address - Fax:845-679-3217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005119-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEU281Medicare PIN