Provider Demographics
NPI:1124174909
Name:DONNELLY, THOMAS PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PATRICK
Last Name:DONNELLY
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 1:400 S MOORE RD
Mailing Address - Street 2:STE E
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-2987
Mailing Address - Country:US
Mailing Address - Phone:423-825-5252
Mailing Address - Fax:423-825-1228
Practice Address - Street 1:5843 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5513
Practice Address - Country:US
Practice Address - Phone:423-825-5252
Practice Address - Fax:423-825-1228
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002422111N00000X
MI2301005701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor