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General NPI Number Information
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NPI Number | 1598162802
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Entity Type | Organization
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Legal Business Name | EDWARD M. BOUNADONNA, D.C., P.A
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 1421 10TH ST
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City | LAKE PARK
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State | FL
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Zip | 33403-2044
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Country | US
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Telephone | 561-863-8898
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Fax | 561-863-8380
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Provider Business Mailing Address
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Address Line | 1421 10TH ST
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City | LAKE PARK
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State | FL
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Zip | 33403-2044
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Country | US
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Telephone | 561-863-8898
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Fax | 561-863-8380
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD M BUONADONNA
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Credential | DC
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Telephone | 561-863-8898
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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 | CH0007117
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License Number State | FL
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