MEDICARE: ROBERT J DE BONIS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X2240	NY
2	111N00000X	Chiropractor	40	VI

General Provider Information

NPI Number	:	1790757474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J DE BONIS D.C.

Provider Business Mailing Address
First Line	:	5000 ESTATE ENIGHED
Second Line	:	PMB #371
City	:	ST JOHN
State	:	VI
Zip	:	00830-6120
Country	:	US
Telephone Number	:	340-775-9950
Fax Number	:

Provider Business Practice Location Address
First Line	:	16213 SPRING GDN
Second Line	:	COCCOLOBA SHOPS
City	:	ST JOHN
State	:	VI
Zip	:	00830-9525
Country	:	US
Telephone Number	:	340-775-9950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/14/2008

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