Provider Demographics
NPI:1649367053
Name:DONNELLY, ROBERT P (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15871 CITY VIEW DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-7304
Mailing Address - Country:US
Mailing Address - Phone:804-897-3478
Mailing Address - Fax:
Practice Address - Street 1:15871 CITY VIEW DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-7304
Practice Address - Country:US
Practice Address - Phone:804-897-3478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU65572Medicare UPIN
VA350001193Medicare ID - Type Unspecified