Provider Demographics
NPI:1598162802
Name:EDWARD M. BOUNADONNA, D.C., P.A
Entity Type:Organization
Organization Name:EDWARD M. BOUNADONNA, D.C., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUONADONNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-863-8898
Mailing Address - Street 1:1421 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2044
Mailing Address - Country:US
Mailing Address - Phone:561-863-8898
Mailing Address - Fax:561-863-8380
Practice Address - Street 1:1421 10TH ST
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2044
Practice Address - Country:US
Practice Address - Phone:561-863-8898
Practice Address - Fax:561-863-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty