Provider Demographics
NPI:1982733390
Name:ROTHEISER, BONNIE L (DC)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:L
Last Name:ROTHEISER
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 1:23123 VENTURA BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1165
Mailing Address - Country:US
Mailing Address - Phone:818-591-0656
Mailing Address - Fax:818-591-7326
Practice Address - Street 1:23123 VENTURA BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1165
Practice Address - Country:US
Practice Address - Phone:818-591-0656
Practice Address - Fax:818-591-7326
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19590111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19590Medicare UPIN