Provider Demographics
NPI:1790757474
Name:DE BONIS, ROBERT J (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:DE BONIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 ESTATE ENIGHED
Mailing Address - Street 2:PMB #371
Mailing Address - City:ST JOHN
Mailing Address - State:VI
Mailing Address - Zip Code:00830-6120
Mailing Address - Country:US
Mailing Address - Phone:340-775-9950
Mailing Address - Fax:
Practice Address - Street 1:16213 SPRING GDN
Practice Address - Street 2:COCCOLOBA SHOPS
Practice Address - City:ST JOHN
Practice Address - State:VI
Practice Address - Zip Code:00830-9525
Practice Address - Country:US
Practice Address - Phone:340-775-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2240111N00000X
VI40111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51997Medicare UPIN
NYX12821Medicare PIN
VI005-8543Medicare PIN