Provider Demographics
NPI:1689048084
Name:BONILLA, ANA LAURA (DC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LAURA
Last Name:BONILLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor