Provider Demographics
NPI:1679759104
Name:JOHN A BONDRA DC INC
Entity Type:Organization
Organization Name:JOHN A BONDRA DC INC
Other - Org Name:MAY-GREEN CHIROPRACTIC CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:BONDRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:216-381-8700
Mailing Address - Street 1:1492 S GREEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4038
Mailing Address - Country:US
Mailing Address - Phone:216-381-8700
Mailing Address - Fax:216-291-4793
Practice Address - Street 1:1492 S GREEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4038
Practice Address - Country:US
Practice Address - Phone:216-381-8700
Practice Address - Fax:216-291-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0999362Medicaid
OH0396193Medicare PIN