Active NPI
David Dean Donaldson, D.C.
- Chiropractor
- Petaluma, CA
National Provider Identifier
1124264858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 15910
- Practice address
- 709 Petaluma Blvd N # B
Petaluma, CA 94952-2106 - Phone
- (707) 772-5154
- Fax
- (707) 762-7508
- NPI assigned
- Dec 30, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 15910 | CA | Primary |
Addresses
Primary practice location
709 Petaluma Blvd N # B
Petaluma, CA 94952-2106
Mailing address
709 Petaluma Blvd N
Suite B
Petaluma, CA 94952-2106
Phone (707) 772-5154
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121025000258 | CA | Practitioner - Chiropractic | 3577713601 | Practice locations: Petaluma, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1983
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
709 Petaluma Blvd N B
Petaluma, CA 94952-2106
Phone (707) 772-5154
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15910 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363651200000",
"number": "1124264858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 PETALUMA BLVD N",
"address_2": "SUITE B",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522106",
"telephone_number": "707-772-5154",
"fax_number": "707-762-7508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 PETALUMA BLVD N # B",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522106",
"telephone_number": "707-772-5154",
"fax_number": "707-762-7508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONALDSON",
"first_name": "DAVID",
"middle_name": "DEAN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-30",
"last_updated": "2013-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "15910",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.