Provider Demographics
NPI:1174612501
Name:DONAHUE, SUSAN M (DC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 EDDIE DOWLING HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-7322
Mailing Address - Country:US
Mailing Address - Phone:401-356-4606
Mailing Address - Fax:401-356-4607
Practice Address - Street 1:63 EDDIE DOWLING HWY
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7322
Practice Address - Country:US
Practice Address - Phone:401-356-4606
Practice Address - Fax:401-356-4607
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI709004107Medicare ID - Type Unspecified
RIV06570Medicare UPIN