Provider Demographics
NPI:1972663235
Name:BONSALL, WILLIAM BOULTON (DC, DACBSP)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BOULTON
Last Name:BONSALL
Suffix:
Gender:M
Credentials:DC, DACBSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-5625
Mailing Address - Country:US
Mailing Address - Phone:908-654-9228
Mailing Address - Fax:908-654-9286
Practice Address - Street 1:812 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-5625
Practice Address - Country:US
Practice Address - Phone:908-654-9228
Practice Address - Fax:908-654-9286
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC3083111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ584892Medicare PIN