Provider Demographics
NPI:1326021007
Name:DANIV, INESSA MARIA (DC)
Entity Type:Individual
Prefix:
First Name:INESSA
Middle Name:MARIA
Last Name:DANIV
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 1:990 E SOUTH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1400
Mailing Address - Country:US
Mailing Address - Phone:248-688-8713
Mailing Address - Fax:248-688-9854
Practice Address - Street 1:990 E SOUTH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1400
Practice Address - Country:US
Practice Address - Phone:248-688-8713
Practice Address - Fax:248-688-9854
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP50510002Medicare PIN