Healthcare Provider Details

I. General information

NPI: 1275858250
Provider Name (Legal Business Name): J. DONBERG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 E EIGHTH ST SUITE 17
TRAVERSE CITY MI
49686-2504
US

IV. Provider business mailing address

626 E EIGHTH ST SUITE 17
TRAVERSE CITY MI
49686-2504
US

V. Phone/Fax

Practice location:
  • Phone: 231-929-8183
  • Fax:
Mailing address:
  • Phone: 231-929-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number100776 NCCAOM
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: MS. JILL MARIE DONBERG
Title or Position: OWNER
Credential: MACOM
Phone: 231-929-8183