Provider Demographics
NPI:1881743771
Name:WRIGHT, DONALD LEE (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEE
Last Name:WRIGHT
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 1:502 PLUMAGE CT
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5616
Mailing Address - Country:US
Mailing Address - Phone:309-452-1800
Mailing Address - Fax:309-454-1919
Practice Address - Street 1:406 N BEECH ST
Practice Address - Street 2:SUITE A
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1999
Practice Address - Country:US
Practice Address - Phone:309-454-1800
Practice Address - Fax:309-454-1919
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038005831Medicaid
IL05715399OtherBLUE CROSS BLUE SHIELD IL
IL759230Medicare PIN