Provider Demographics
NPI:1700942356
Name:BONANNO, CHARLES F (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:BONANNO
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 1:357 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1654
Mailing Address - Country:US
Mailing Address - Phone:973-546-4400
Mailing Address - Fax:973-546-5459
Practice Address - Street 1:357 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1654
Practice Address - Country:US
Practice Address - Phone:973-546-4400
Practice Address - Fax:973-546-5459
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-3570988OtherTAX ID
NJ470013Medicare ID - Type Unspecified