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General NPI Number Information
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NPI Number | 1376812362
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Entity Type | Organization
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Legal Business Name | REDLANDS SPINE AND SPORT
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 219 E OLIVE AVE
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City | REDLANDS
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State | CA
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Zip | 92373-5251
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Country | US
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Telephone | 909-793-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 219 E OLIVE AVE
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City | REDLANDS
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State | CA
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Zip | 92373-5251
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Country | US
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Telephone | 909-793-2225
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Fax |
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | DR. MICHAEL S DONIA
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Credential | DC
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Telephone | 909-793-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC-28061
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License Number State | CA
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