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General NPI Number Information
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NPI Number | 1033488168
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Entity Type | Organization
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Legal Business Name | ATRIUM CHIROPRACTIC AND REHAB, INC.
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 3900 NW 79TH AVE SUITE 201
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City | DORAL
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State | FL
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Zip | 33166-6556
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Country | US
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Telephone | 305-599-8800
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Fax | 305-599-8877
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Provider Business Mailing Address
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Address Line | 3900 NW 79TH AVE SUITE 201
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City | DORAL
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State | FL
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Zip | 33166-6556
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Country | US
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Telephone | 305-599-8800
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Fax | 305-599-8877
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARLOS DANIEL BONILLA
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Credential | D.C.
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Telephone | 305-599-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8994
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License Number State | FL
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