Provider Demographics
NPI:1831509348
Name:BONITA SPRINGS CHIROPRACTIC CORP
Entity type:Organization
Organization Name:BONITA SPRINGS CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:RAFEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-253-8362
Mailing Address - Street 1:23540 VIA VENETO BLVD
Mailing Address - Street 2:#505
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4923
Mailing Address - Country:US
Mailing Address - Phone:513-253-8362
Mailing Address - Fax:
Practice Address - Street 1:3440 RENAISSANCE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7004
Practice Address - Country:US
Practice Address - Phone:513-253-8362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty