Healthcare Provider Details

I. General information

NPI: 1932777364
Provider Name (Legal Business Name): MITCHELL BONNSTETTER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 W 5TH AVE
COLUMBUS OH
43212-2321
US

IV. Provider business mailing address

1806 W 5TH AVE
COLUMBUS OH
43212-2321
US

V. Phone/Fax

Practice location:
  • Phone: 614-549-6293
  • Fax:
Mailing address:
  • Phone: 614-549-6293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-04961
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC-04961
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: