Provider Demographics
NPI:1457343691
Name:DONALDSON, HOLLY BETH (DC)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:BETH
Last Name:DONALDSON
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 1:335 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3066
Mailing Address - Country:US
Mailing Address - Phone:231-929-1335
Mailing Address - Fax:231-929-1336
Practice Address - Street 1:335 DAVIS ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3066
Practice Address - Country:US
Practice Address - Phone:231-929-1335
Practice Address - Fax:231-929-1336
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHD006072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950B85201OtherBCBS
MI2953479Medicaid
OB85201Medicare ID - Type Unspecified
950B85201OtherBCBS
MI0B85201Medicare PIN