MEDICARE: DR. CHARLES F BONANNO D.C

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	MC03621	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22-3570988	OTHER	NJ	TAX ID

General Provider Information

NPI Number	:	1700942356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES F BONANNO D.C

Provider Business Mailing Address
First Line	:	357 MIDLAND AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-1654
Country	:	US
Telephone Number	:	973-546-4400
Fax Number	:	973-546-5459

Provider Business Practice Location Address
First Line	:	357 MIDLAND AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-1654
Country	:	US
Telephone Number	:	973-546-4400
Fax Number	:	973-546-5459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	01/07/2013

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Directions to “ DR. CHARLES F BONANNO D.C” Practice Location

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