Healthcare Provider Details

I. General information

NPI: 1639419989
Provider Name (Legal Business Name): ALLISON M BONHAM D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E ALEX BELL RD STE #186
CENTERVILLE OH
45459-2753
US

IV. Provider business mailing address

101 E ALEX BELL RD STE #186
CENTERVILLE OH
45459-2753
US

V. Phone/Fax

Practice location:
  • Phone: 937-416-5957
  • Fax:
Mailing address:
  • Phone: 937-416-5957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberDC0000002618
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number4370
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: