Provider Demographics
NPI:1730614181
Name:BONILLA CHIROPRACTIC
Entity type:Organization
Organization Name:BONILLA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-573-1133
Mailing Address - Street 1:4606 FM 1960 RD W STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4615
Mailing Address - Country:US
Mailing Address - Phone:832-384-9112
Mailing Address - Fax:832-384-9115
Practice Address - Street 1:4606 FM 1960 RD W STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4615
Practice Address - Country:US
Practice Address - Phone:832-384-9112
Practice Address - Fax:832-384-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty