Provider Demographics
NPI:1528146032
Name:BONT CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:BONT CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BONT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-483-3913
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-0579
Mailing Address - Country:US
Mailing Address - Phone:715-483-3913
Mailing Address - Fax:715-483-3098
Practice Address - Street 1:144 NORTH ADAMS STREET
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024
Practice Address - Country:US
Practice Address - Phone:715-483-3913
Practice Address - Fax:715-483-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38731700Medicaid
MN09N78CROtherBLUE CROSS
WI38731700Medicaid