MEDICARE: DR. ANDREW THOMAS BONNEAU 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	DC005630	PA
2	111N00000X	Chiropractor	AJ005630L	PA

General Provider Information

NPI Number	:	1841296142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW THOMAS BONNEAU D.C.

Provider Business Mailing Address
First Line	:	2921 SOUTH PARK RD.
Second Line	:
City	:	BETHEL PARK
State	:	PA
Zip	:	15102-1682
Country	:	US
Telephone Number	:	412-833-4133
Fax Number	:	412-833-4133

Provider Business Practice Location Address
First Line	:	2921 SOUTH PARK RD.
Second Line	:
City	:	BETHEL PARK
State	:	PA
Zip	:	15102-1682
Country	:	US
Telephone Number	:	412-833-4133
Fax Number	:	412-833-4133

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/09/2007

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