Provider Demographics
NPI:1578169181
Name:CLARK, DANIELLE ABITZ (DC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ABITZ
Last Name:CLARK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:SARAH
Other - Last Name:ABITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:188 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1287
Mailing Address - Country:US
Mailing Address - Phone:262-995-5092
Mailing Address - Fax:
Practice Address - Street 1:8175 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5377
Practice Address - Country:US
Practice Address - Phone:269-324-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301011030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor