Provider Demographics
NPI:1710070628
Name:BONACCI, MARC ALBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALBERT
Last Name:BONACCI
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Gender:M
Credentials:DO
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Mailing Address - Street 1:7320 E DEER VALLEY RD
Mailing Address - Street 2:SUITE J100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7453
Mailing Address - Country:US
Mailing Address - Phone:480-585-0252
Mailing Address - Fax:480-502-4336
Practice Address - Street 1:7320 E. DEER VALLEY ROAD
Practice Address - Street 2:SUITE J100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255
Practice Address - Country:US
Practice Address - Phone:480-585-0252
Practice Address - Fax:480-502-4336
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ5814111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU70541Medicare UPIN