Provider Demographics
NPI:1427100916
Name:DONOVAN, KELLY LYNN (DC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:DONOVAN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WOBURN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3022
Mailing Address - Country:US
Mailing Address - Phone:781-944-1600
Mailing Address - Fax:781-942-8700
Practice Address - Street 1:22 WOBURN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3022
Practice Address - Country:US
Practice Address - Phone:781-944-1600
Practice Address - Fax:781-942-8700
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36197OtherBLUE CROSS
MA44-04408OtherUNITED HEALTH
MAB20377301OtherCIGNA
MA35845OtherHARVARD PILGRAM
MA565306OtherAETNA
MA731141OtherTUFTS
MAY36197Medicare ID - Type Unspecified