Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00641800 | NJ |
NPI | 1003032384 |
---|---|
Provider Name | Dr. Ralph Bonocore |
First Address | Clifton, NJ 07011-2674 |
Second Address | Chatham, NJ 07928-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 09/03/2008 |