MEDICARE: CHRISTINE O'DONOHUE 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	X010296	NY

General Provider Information

NPI Number	:	1659458180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE O'DONOHUE D.C.

Provider Business Mailing Address
First Line	:	63 MCKEE ST
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-1617
Country	:	US
Telephone Number	:	516-216-5061
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 W 35TH ST
Second Line	:	2ND FL
City	:	NEW YORK
State	:	NY
Zip	:	10001-1904
Country	:	US
Telephone Number	:	212-239-4544
Fax Number	:	212-290-2991

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/12/2008

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