Provider Demographics
NPI:1023078060
Name:BONINA, JOSEPH LOUIS (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LOUIS
Last Name:BONINA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-4719
Mailing Address - Country:US
Mailing Address - Phone:508-790-4100
Mailing Address - Fax:508-790-4111
Practice Address - Street 1:403 ROUTE 28
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-4719
Practice Address - Country:US
Practice Address - Phone:508-790-4100
Practice Address - Fax:508-790-4111
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39483OtherBCBSMA GROUP #
MAY35965OtherBCBSMA INDIV.#
MA35271OtherHARVARD PILGRIM HEALTH
MA596100OtherCIGNA HEALTH PLAN
MA001343OtherTUFTS HEALTH PLAN
MAY39483OtherBCBSMA GROUP #
MAY35965OtherBCBSMA INDIV.#