MEDICARE: EDWARD M. BOUNADONNA, D.C., P.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH0007117	FL

General Provider Information

NPI Number	:	1598162802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD M. BOUNADONNA, D.C., P.A

Provider Business Mailing Address
First Line	:	1421 10TH ST
Second Line	:
City	:	LAKE PARK
State	:	FL
Zip	:	33403-2044
Country	:	US
Telephone Number	:	561-863-8898
Fax Number	:	561-863-8380

Provider Business Practice Location Address
First Line	:	1421 10TH ST
Second Line	:
City	:	LAKE PARK
State	:	FL
Zip	:	33403-2044
Country	:	US
Telephone Number	:	561-863-8898
Fax Number	:	561-863-8380

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD M BUONADONNA
Credential	:	DC
Telephone Number	:	561-863-8898

Provider Enumeration Date	:	12/02/2014
Last Update Date	:	08/23/2019

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