Provider Demographics
NPI:1235151499
Name:COROSANITE, DANA L (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:L
Last Name:COROSANITE
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 1:3872 SNOWDEN LN
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8644
Mailing Address - Country:US
Mailing Address - Phone:248-624-6111
Mailing Address - Fax:248-624-6129
Practice Address - Street 1:1183 N PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3138
Practice Address - Country:US
Practice Address - Phone:248-624-6111
Practice Address - Fax:248-624-6129
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF36387008Medicare ID - Type Unspecified