Provider Demographics
NPI:1255598132
Name:JANISSE, DONNA JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JEAN
Last Name:JANISSE
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 1:28982 DRAKES BAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4670
Mailing Address - Country:US
Mailing Address - Phone:972-841-7008
Mailing Address - Fax:206-350-3779
Practice Address - Street 1:28982 DRAKES BAY
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4670
Practice Address - Country:US
Practice Address - Phone:972-841-7008
Practice Address - Fax:206-350-3779
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3853111NX0100X
CADC24427111NX0100X
TX10704111NX0100X
MS1116111NX0100X
KY5070111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health