Provider Demographics
NPI:1245569128
Name:GENERATION CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:GENERATION CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BONINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-699-0500
Mailing Address - Street 1:5999 DE ZAVALA RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2233
Mailing Address - Country:US
Mailing Address - Phone:210-699-0500
Mailing Address - Fax:210-699-0501
Practice Address - Street 1:5999 DE ZAVALA RD
Practice Address - Street 2:SUITE 145
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2233
Practice Address - Country:US
Practice Address - Phone:210-699-0500
Practice Address - Fax:210-699-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty