Provider Demographics
NPI:1649343286
Name:NESS, BONNIE LEE (DC)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LEE
Last Name:NESS
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 1:9100 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-3740
Mailing Address - Country:US
Mailing Address - Phone:949-306-9938
Mailing Address - Fax:
Practice Address - Street 1:23028 LAKE FOREST DR
Practice Address - Street 2:SUITE D
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1323
Practice Address - Country:US
Practice Address - Phone:949-306-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001488111N00000X
CA33032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU65162Medicare UPIN
VAU65162Medicare UPIN