Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 1681 | OR |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1681 | OR |
NPI | 1730264672 |
---|---|
Provider Name | Bonnie Malone |
First Address | Sisters, OR 97759-0718 |
Second Address | Sisters, OR 97759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 15/09/2010 |