MEDICARE: O DONAHUE CHIROPRACTIC PC

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	2740	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2454001	OTHER	NC	MEDICARE P-TAN

General Provider Information

NPI Number	:	1770681074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O DONAHUE CHIROPRACTIC PC

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

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JAMES M O'DONAHUE JR.
Credential	:	D.C.
Telephone Number	:	252-756-0837

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/15/2014

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Directions to “O DONAHUE CHIROPRACTIC PC ” Practice Location

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