Healthcare Provider Details

I. General information

NPI: 1063417582
Provider Name (Legal Business Name): BERNARD M NONTE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 S EXECUTIVE BLVD
JASPER IN
47546-3503
US

IV. Provider business mailing address

1450 S EXECUTIVE BLVD
JASPER IN
47546-3503
US

V. Phone/Fax

Practice location:
  • Phone: 812-634-2474
  • Fax: 812-634-6038
Mailing address:
  • Phone: 812-634-2474
  • Fax: 812-634-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number754
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: