Provider Demographics
NPI:1942226659
Name:DONATHAN FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DONATHAN FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DONATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-283-3200
Mailing Address - Street 1:17533 FORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-6630
Mailing Address - Country:US
Mailing Address - Phone:734-283-3200
Mailing Address - Fax:734-283-5541
Practice Address - Street 1:17533 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-6630
Practice Address - Country:US
Practice Address - Phone:734-283-3200
Practice Address - Fax:734-283-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007586111NN1001X
MI2301008033111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4673483Medicaid
MI0P09090Medicare PIN
MIU99441Medicare UPIN