Provider Demographics
NPI:1417957846
Name:BONEBRAKE, ALAN RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RAY
Last Name:BONEBRAKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:630 N CENTRAL EXPY
Mailing Address - Street 2:SUITE C
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6895
Mailing Address - Country:US
Mailing Address - Phone:469-995-9907
Mailing Address - Fax:972-692-5174
Practice Address - Street 1:630 N CENTRAL EXPY
Practice Address - Street 2:SUITE C
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6895
Practice Address - Country:US
Practice Address - Phone:469-995-9907
Practice Address - Fax:972-692-5174
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5138111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition