Provider Demographics
NPI:1265536858
Name:DONNELLY, BETH L (DC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:L
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571
Mailing Address - Country:US
Mailing Address - Phone:845-758-3585
Mailing Address - Fax:845-758-3585
Practice Address - Street 1:7468 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571
Practice Address - Country:US
Practice Address - Phone:845-758-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-005726-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY911944OtherMANAGED PHYSICAL NETWORK
NYCO5726OtherWORKERS COMP
NY911944OtherMANAGED PHYSICAL NETWORK