MEDICARE: MRS. KATHRYN MARIE DONOVAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3224	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2157492	OTHER	MN	FIRST HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	231905	OTHER	MN	CHIROCARE
4	62G00DO	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1053304386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN MARIE DONOVAN D.C.

Provider Business Mailing Address
First Line	:	4961 RICE LAKE RD
Second Line	:	SUITE #103
City	:	DULUTH
State	:	MN
Zip	:	55803-8438
Country	:	US
Telephone Number	:	218-391-9976
Fax Number	:

Provider Business Practice Location Address
First Line	:	4961 RICE LAKE RD
Second Line	:	SUITE #103
City	:	DULUTH
State	:	MN
Zip	:	55803-8438
Country	:	US
Telephone Number	:	218-391-9976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/20/2012

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