Provider Demographics
NPI:1588876270
Name:DONNELLY, MARTIN C (DC,)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:C
Last Name:DONNELLY
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 1:1401 N ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3337
Mailing Address - Country:US
Mailing Address - Phone:703-465-1213
Mailing Address - Fax:703-465-1211
Practice Address - Street 1:1401 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3337
Practice Address - Country:US
Practice Address - Phone:703-465-1213
Practice Address - Fax:703-465-1211
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556372111N00000X
CT7.002086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
602196300OtherDEPT OF LABOR
07950876OtherAETNA PPO
698870OtherCIGNA PPO
200994125OtherUNITED HEALTHCARE
2159023OtherMAMSI
2159023OtherMDIPA
200994125OtherPHCS
2159023OtherOPTIMUM CHOICE
1066011OtherAETNA HMO
200994125OtherGOLDEN RULE
K218Other200994125
1066011OtherASHN CIGNA HMO
196849OtherANTHEM
20994125OtherKAISER
2159023OtherALLIANCE