Provider Demographics
NPI:1972673796
Name:DONOFRIO, ROBERT LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:DONOFRIO
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 1:450 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2002
Mailing Address - Country:US
Mailing Address - Phone:630-834-1114
Mailing Address - Fax:630-834-3115
Practice Address - Street 1:450 N YORK ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2002
Practice Address - Country:US
Practice Address - Phone:630-834-1114
Practice Address - Fax:630-834-3115
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
02208440OtherBCBS
350042924OtherRAILROAD MEDICARE
350042924OtherRAILROAD MEDICARE
U66715Medicare UPIN