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General NPI Number Information
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NPI Number | 1851813745
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Entity Type | Organization
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Legal Business Name | BONITA BEACH CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 03/09/2018
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Provider Practice Location Address
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Address Line | 11100 BONITA BEACH RD SE STE 107B
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-5701
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Country | US
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Telephone | 314-919-7399
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Fax |
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Provider Business Mailing Address
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Address Line | 3470 CARTWRIGHT CT
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-7575
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ANNIE RAY
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Credential | DC
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Telephone | 239-992-6643
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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 | CH11185
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License Number State |
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