Provider Demographics
NPI:1467500165
Name:CURTIS-MACDONALD, ANITA (DC)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:CURTIS-MACDONALD
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 1:23760 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:MI
Mailing Address - Zip Code:49451-9604
Mailing Address - Country:US
Mailing Address - Phone:231-853-8300
Mailing Address - Fax:231-853-8300
Practice Address - Street 1:23760 36TH AVE
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:MI
Practice Address - Zip Code:49451-9604
Practice Address - Country:US
Practice Address - Phone:231-853-8300
Practice Address - Fax:231-853-8300
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007461111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M43180Medicare ID - Type Unspecified
MI950F150280Medicare UPIN