Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 14369 | TX |
NPI | 1003448507 |
---|---|
Provider Name | Dr. Jennifer Bonilla |
First Address | San Antonio, TX 78270-0688 |
Second Address | El Paso, TX 79912-5427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2020 |
Last Update Date | 12/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14369 | TEXAS BOARD OF CHIROPRACTIC (01) | TX |