Provider Demographics
NPI:1922085315
Name:WARREN, DONALD PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PAUL
Last Name:WARREN
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:PO BOX 139
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-0139
Mailing Address - Country:US
Mailing Address - Phone:574-679-0100
Mailing Address - Fax:574-675-9586
Practice Address - Street 1:5432 LINCOLNWAY EAST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561
Practice Address - Country:US
Practice Address - Phone:574-679-0100
Practice Address - Fax:574-675-9586
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000089524OtherANTHEM
IN100468590Medicaid
IN168920OtherPTAN
IN100468590Medicaid