Provider Demographics
NPI:1114216579
Name:HARDER, BONNIE LINN (DC)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LINN
Last Name:HARDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16547 E MCNEAL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE CENTER
Mailing Address - State:IL
Mailing Address - Zip Code:61052-9719
Mailing Address - Country:US
Mailing Address - Phone:815-757-0425
Mailing Address - Fax:
Practice Address - Street 1:650 N PEACE RD
Practice Address - Street 2:SUITE C
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-8401
Practice Address - Country:US
Practice Address - Phone:815-748-3102
Practice Address - Fax:877-991-9641
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4750-12111N00000X
IL038011913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL440630001OtherMEDICARE PTAN