Healthcare Provider Details

I. General information

NPI: 1942226659
Provider Name (Legal Business Name): DONATHAN FAMILY CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17533 FORT ST
RIVERVIEW MI
48193-6630
US

IV. Provider business mailing address

17533 FORT ST
RIVERVIEW MI
48193-6630
US

V. Phone/Fax

Practice location:
  • Phone: 734-283-3200
  • Fax: 734-283-5541
Mailing address:
  • Phone: 734-283-3200
  • Fax: 734-283-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2301008033
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2301007586
License Number StateMI

VIII. Authorized Official

Name: DR. KEVIN JAMES DONATHAN
Title or Position: CHAIRMAN OF THE BOARD
Credential: DC
Phone: 734-283-3200