Provider Demographics
NPI:1942366711
Name:BONNER, NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:CONZOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:691 MILL CREEK RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3531
Mailing Address - Country:US
Mailing Address - Phone:609-978-4304
Mailing Address - Fax:609-978-5585
Practice Address - Street 1:691 MILL CREEK RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3531
Practice Address - Country:US
Practice Address - Phone:609-978-4304
Practice Address - Fax:609-978-5585
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00586700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ059780Medicare ID - Type Unspecified