Provider Demographics
NPI:1841391414
Name:MYHERS, BONITA R (DC)
Entity Type:Individual
Prefix:DR
First Name:BONITA
Middle Name:R
Last Name:MYHERS
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:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:WI
Mailing Address - Zip Code:54758-0336
Mailing Address - Country:US
Mailing Address - Phone:715-597-3388
Mailing Address - Fax:715-597-2688
Practice Address - Street 1:13818 7TH ST
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:WI
Practice Address - Zip Code:54758-7402
Practice Address - Country:US
Practice Address - Phone:715-597-3388
Practice Address - Fax:715-597-2688
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3101-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38891100Medicaid
WI38891100Medicaid
WI35587Medicare ID - Type Unspecified