Provider Demographics
NPI:1922778547
Name:BONTE, AMY TALEI (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:TALEI
Last Name:BONTE
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 1:1182 BRISTOL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-8602
Mailing Address - Country:US
Mailing Address - Phone:714-957-6889
Mailing Address - Fax:714-546-8616
Practice Address - Street 1:1182 BRISTOL ST STE 100
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-8602
Practice Address - Country:US
Practice Address - Phone:714-957-6889
Practice Address - Fax:714-546-8616
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC35003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor