Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC-008033-L | PA |
NPI | 1003991894 |
---|---|
Provider Name | Dr. George Patrick Bonner |
First Address | Philadelphia, PA 19125-2917 |
Second Address | Philadelphia, PA 19134-5607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |