Provider Demographics
NPI:1720083298
Name:INNAIMO, DONN ANTHONY (DC)
Entity Type:Individual
Prefix:MR
First Name:DONN
Middle Name:ANTHONY
Last Name:INNAIMO
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 1:380 MAIN ST
Mailing Address - Street 2:STE 5
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2260
Mailing Address - Country:US
Mailing Address - Phone:860-274-8858
Mailing Address - Fax:860-945-6355
Practice Address - Street 1:380 MAIN ST
Practice Address - Street 2:STE 5
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2260
Practice Address - Country:US
Practice Address - Phone:860-274-8858
Practice Address - Fax:860-945-6355
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00405146Medicaid
00405146200OtherBLUE CARE FAMILY PLAN
CT00346OtherLANDMARK
0461226OtherAETNA HMO
050000346CT07OtherANTHEM BC/BS
102035000OtherASHN
4210015OtherAETHNA PPO
6596401003OtherCIGNA