MEDICARE: DONOGHUE 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	X005119-1	NY

General Provider Information

NPI Number	:	1891976973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONOGHUE CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	PO BOX 368
Second Line	:
City	:	WEST HURLEY
State	:	NY
Zip	:	12491-0368
Country	:	US
Telephone Number	:	845-679-1253
Fax Number	:	845-679-3217

Provider Business Practice Location Address
First Line	:	1314 ROUTE 28
Second Line	:
City	:	WEST HURLEY
State	:	NY
Zip	:	12491-0368
Country	:	US
Telephone Number	:	845-679-1253
Fax Number	:	845-679-3217

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTOPHER FRANCES DONOGHUE JR.
Credential	:	DC
Telephone Number	:	845-679-1253

Provider Enumeration Date	:	11/17/2007
Last Update Date	:	11/17/2007

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