Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301011127 | MI |
NPI | 1003589003 |
---|---|
Provider Name | Dr. Emily Leona Bondar |
First Address | Southgate, MI 48195-3054 |
Second Address | Southgate, MI 48195-3054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2021 |
Last Update Date | 27/07/2021 |