Provider Demographics
NPI:1124264858
Name:DONALDSON, DAVID DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DEAN
Last Name:DONALDSON
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 1:709 PETALUMA BLVD N
Mailing Address - Street 2:SUITE B
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2106
Mailing Address - Country:US
Mailing Address - Phone:707-772-5154
Mailing Address - Fax:707-762-7508
Practice Address - Street 1:709 PETALUMA BLVD N # B
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2106
Practice Address - Country:US
Practice Address - Phone:707-772-5154
Practice Address - Fax:707-762-7508
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor