Provider Demographics
NPI:1447661897
Name:JEFFREY G. DONATELLO, DC, LLC
Entity type:Organization
Organization Name:JEFFREY G. DONATELLO, DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DONATELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-438-9339
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-0416
Mailing Address - Country:US
Mailing Address - Phone:207-438-9339
Mailing Address - Fax:207-438-9009
Practice Address - Street 1:76 US ROUTE 1 BY-PASS
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904
Practice Address - Country:US
Practice Address - Phone:207-438-9339
Practice Address - Fax:207-438-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty