Healthcare Provider Details

I. General information

NPI: 1326066978
Provider Name (Legal Business Name): CHRISTOPHER L BONIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E SHEA BLVD STE 165
PHOENIX AZ
85028-6042
US

IV. Provider business mailing address

4530 E SHEA BLVD STE 165
PHOENIX AZ
85028-6042
US

V. Phone/Fax

Practice location:
  • Phone: 602-603-1490
  • Fax:
Mailing address:
  • Phone: 602-603-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number4118
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7432
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: