MEDICARE: DR. JAMES M O'DONAHUE JR. B.A., B.S., 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	NC2740	NC

General Provider Information

NPI Number	:	1316922180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M O'DONAHUE JR. B.A., B.S., D.C.

Provider Business Mailing Address
First Line	:	915 E. FIRETOWER RD SUITE 104
Second Line	:	O'DONAHUE CHIROPRACTIC
City	:	WINTERVILLE
State	:	NC
Zip	:	28590
Country	:	US
Telephone Number	:	252-756-0837
Fax Number	:	252-756-7718

Provider Business Practice Location Address
First Line	:	915 E FIRE TOWER RD STE 104
Second Line	:	O'DONAHUE CHIROPRACTIC
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-9398
Country	:	US
Telephone Number	:	252-756-0837
Fax Number	:	252-756-7718

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	02/26/2013

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