Provider Demographics
NPI:1245535236
Name:DONOVAN, CRAIG E (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:E
Last Name:DONOVAN
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 1:2320 130TH AVE NE STE 210
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1752
Mailing Address - Country:US
Mailing Address - Phone:425-688-7901
Mailing Address - Fax:
Practice Address - Street 1:2320 130TH AVE NE STE 210
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1752
Practice Address - Country:US
Practice Address - Phone:425-688-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31691111N00000X
WACH 60171316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor