Provider Demographics
NPI:1508240870
Name:BONDURANT FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BONDURANT FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DICCP
Authorized Official - Phone:319-400-2668
Mailing Address - Street 1:301 CENTER AVE S
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50169-9751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 2ND ST NE STE C
Practice Address - Street 2:
Practice Address - City:BONDURANT
Practice Address - State:IA
Practice Address - Zip Code:50035-1336
Practice Address - Country:US
Practice Address - Phone:319-400-2668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007522111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB236702Medicare PIN