Provider Demographics
NPI:1295782845
Name:BRONSON, AMY ALICE (DC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ALICE
Last Name:BRONSON
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 1:200 CHARLOIS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1536
Mailing Address - Country:US
Mailing Address - Phone:336-765-0404
Mailing Address - Fax:336-765-0304
Practice Address - Street 1:200 CHARLOIS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1536
Practice Address - Country:US
Practice Address - Phone:336-765-0404
Practice Address - Fax:336-765-0304
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor