Provider Demographics
NPI:1538453220
Name:RUPPERT, BONNIE LYN (DC)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LYN
Last Name:RUPPERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:LYN
Other - Last Name:ZRALLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1924 WREN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-5635
Mailing Address - Country:US
Mailing Address - Phone:772-405-7877
Mailing Address - Fax:
Practice Address - Street 1:4842 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-2243
Practice Address - Country:US
Practice Address - Phone:772-405-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor