Provider Demographics
NPI:1407255037
Name:BONITATIBUS, DORI R (DC)
Entity Type:Individual
Prefix:MRS
First Name:DORI
Middle Name:R
Last Name:BONITATIBUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 HEBRON PKWY #602
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057
Mailing Address - Country:US
Mailing Address - Phone:972-221-2225
Mailing Address - Fax:972-219-2225
Practice Address - Street 1:870 HEBRON PKWY #602
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057
Practice Address - Country:US
Practice Address - Phone:972-221-2225
Practice Address - Fax:972-219-2225
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor