Provider Demographics
NPI:1275858250
Name:J. DONBERG, LLC
Entity Type:Organization
Organization Name:J. DONBERG, LLC
Other - Org Name:GRAND TRAVERSE NATURAL HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DONBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MACOM
Authorized Official - Phone:231-929-8183
Mailing Address - Street 1:626 E EIGHTH ST
Mailing Address - Street 2:SUITE 17
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2504
Mailing Address - Country:US
Mailing Address - Phone:231-929-8183
Mailing Address - Fax:
Practice Address - Street 1:626 E EIGHTH ST
Practice Address - Street 2:SUITE 17
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2504
Practice Address - Country:US
Practice Address - Phone:231-929-8183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
100776 NCCAOM171100000X
175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty