Provider Demographics
NPI:1285734251
Name:DONNELLY, ANNETTE T (CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:T
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35-24 78ST
Mailing Address - Street 2:APT B14
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-803-9100
Mailing Address - Fax:718-639-3065
Practice Address - Street 1:35-24 78ST
Practice Address - Street 2:APT B14
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-803-9100
Practice Address - Fax:718-639-3065
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY68956Medicare ID - Type Unspecified