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General NPI Number Information
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NPI Number | 1245569128
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Entity Type | Organization
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Legal Business Name | GENERATION CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 12/23/2009
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Last Update Date | 12/23/2009
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Provider Practice Location Address
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Address Line | 5999 DE ZAVALA RD SUITE 145
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2233
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Country | US
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Telephone | 210-699-0500
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Fax | 210-699-0501
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Provider Business Mailing Address
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Address Line | 5999 DE ZAVALA RD SUITE 145
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2233
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Country | US
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Telephone | 210-699-0500
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Fax | 210-699-0501
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JOSHUA DOUGLAS BONINE
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Credential | D.C.
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Telephone | 210-699-0500
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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 | 11173
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License Number State | TX
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