Provider Demographics
NPI:1255792933
Name:BUONICONTI, JOHN (DC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BUONICONTI
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 1:1935 BROKEN OAK STREET
Mailing Address - Street 2:UNIT 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:847-271-7612
Mailing Address - Fax:
Practice Address - Street 1:1935 BROKEN OAK ST
Practice Address - Street 2:UNIT 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3100
Practice Address - Country:US
Practice Address - Phone:847-271-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor