Provider Demographics
NPI:1336467992
Name:BONNER, NATASHA (DC)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:POLIVKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 W MAIN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8020
Mailing Address - Country:US
Mailing Address - Phone:214-514-8274
Mailing Address - Fax:
Practice Address - Street 1:1108 TIMBERBEND TRL
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-2949
Practice Address - Country:US
Practice Address - Phone:469-422-0316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor