MEDICARE: ROBERT P DONNELLY 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	0104001608	VA

General Provider Information

NPI Number	:	1649367053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT P DONNELLY D.C.

Provider Business Mailing Address
First Line	:	15871 CITY VIEW DR
Second Line	:	SUITE 140
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-7304
Country	:	US
Telephone Number	:	804-897-3478
Fax Number	:

Provider Business Practice Location Address
First Line	:	15871 CITY VIEW DR
Second Line	:	SUITE 140
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-7304
Country	:	US
Telephone Number	:	804-897-3478
Fax Number	:

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	01/25/2010

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