Provider Demographics
NPI:1659746089
Name:BONILLA FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BONILLA FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-457-6485
Mailing Address - Street 1:3630 N SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6630
Mailing Address - Country:US
Mailing Address - Phone:787-457-6485
Mailing Address - Fax:
Practice Address - Street 1:3630 N SHILOH RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6630
Practice Address - Country:US
Practice Address - Phone:787-457-6485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty