Provider Demographics
NPI:1336205400
Name:DONOGHUE, MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:DONOGHUE
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 1:111 BARCLAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3610
Mailing Address - Country:US
Mailing Address - Phone:847-634-1115
Mailing Address - Fax:847-634-5521
Practice Address - Street 1:111 BARCLAY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3610
Practice Address - Country:US
Practice Address - Phone:847-634-1115
Practice Address - Fax:847-634-5521
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005183111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210295Medicare ID - Type Unspecified
ILT38339Medicare UPIN