Healthcare Provider Details

I. General information

NPI: 1922340199
Provider Name (Legal Business Name): DANIEL C SCHACKMANN MA LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W CHISHOLM ST
ALPENA MI
49707-1401
US

IV. Provider business mailing address

1501 W CHISHOLM ST
ALPENA MI
49707-1401
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-7242
  • Fax: 989-356-7320
Mailing address:
  • Phone: 989-356-7242
  • Fax: 989-356-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301007236
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: