Healthcare Provider Details

I. General information

NPI: 1144790213
Provider Name (Legal Business Name): BONNIE JILL WALINSKY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10752 BUSTLETON AVE
PHILADELPHIA PA
19116-3367
US

IV. Provider business mailing address

10752 BUSTLETON AVE
PHILADELPHIA PA
19116-3367
US

V. Phone/Fax

Practice location:
  • Phone: 215-613-5929
  • Fax:
Mailing address:
  • Phone: 215-613-5929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007505L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: