Provider Demographics
NPI:1407907918
Name:PHILLIPS, BONNIE K (DC)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:K
Last Name:PHILLIPS
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 1:826 WARREN DR
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1365
Mailing Address - Country:US
Mailing Address - Phone:404-625-4785
Mailing Address - Fax:
Practice Address - Street 1:194 JONESBORO RD
Practice Address - Street 2:SUITE H
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4812
Practice Address - Country:US
Practice Address - Phone:770-603-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor