Provider Demographics
NPI:1902871460
Name:DONNER, JONATHAN L (DC PC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:L
Last Name:DONNER
Suffix:
Gender:M
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 PITTSFORD PALMYRA RD
Mailing Address - Street 2:SUITE E9
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3407
Mailing Address - Country:US
Mailing Address - Phone:585-223-1580
Mailing Address - Fax:
Practice Address - Street 1:6605 PITTSFORD PALMYRA RD
Practice Address - Street 2:SUITE E9
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3407
Practice Address - Country:US
Practice Address - Phone:585-223-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX08805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX08805OtherNYS LISENCE
NYCC8342Medicare ID - Type UnspecifiedMEDICARE #