Provider Demographics
NPI:1316922180
Name:O'DONAHUE, JAMES M JR (BA, BS, DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:O'DONAHUE
Suffix:JR
Gender:M
Credentials:BA, BS, DC
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Mailing Address - Street 1:915 E. FIRETOWER RD SUITE 104
Mailing Address - Street 2:O'DONAHUE CHIROPRACTIC
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590
Mailing Address - Country:US
Mailing Address - Phone:252-756-0837
Mailing Address - Fax:252-756-7718
Practice Address - Street 1:915 E FIRE TOWER RD STE 104
Practice Address - Street 2:O'DONAHUE CHIROPRACTIC
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9398
Practice Address - Country:US
Practice Address - Phone:252-756-0837
Practice Address - Fax:252-756-7718
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-02-26
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Provider Licenses
StateLicense IDTaxonomies
NCNC2740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2453981Medicare ID - Type Unspecified
NCU78958Medicare UPIN