Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 11894 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 11894 | CA |
NPI | 1023049467 |
---|---|
Provider Name | Dr. Thomas R Donovan |
First Address | Lafayette, CA 94549-4084 |
Second Address | Lafayette, CA 94549-4084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 10/12/2009 |