Provider Demographics
NPI:1356496996
Name:DONIA, MICHAEL SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SAMUEL
Last Name:DONIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5251
Mailing Address - Country:US
Mailing Address - Phone:909-793-2225
Mailing Address - Fax:909-793-2221
Practice Address - Street 1:219 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5251
Practice Address - Country:US
Practice Address - Phone:909-793-2225
Practice Address - Fax:909-793-2221
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28061111N00000X, 111NS0005X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV08902Medicare UPIN
CADC28061Medicare ID - Type Unspecified