Healthcare Provider Details

I. General information

NPI: 1790757474
Provider Name (Legal Business Name): ROBERT J DE BONIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16213 SPRING GDN COCCOLOBA SHOPS
ST JOHN VI
00830-9525
US

IV. Provider business mailing address

5000 ESTATE ENIGHED PMB #371
ST JOHN VI
00830-6120
US

V. Phone/Fax

Practice location:
  • Phone: 340-775-9950
  • Fax:
Mailing address:
  • Phone: 340-775-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX2240
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number40
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: