Provider Demographics
NPI:1124293931
Name:BONTRAGER, JOHN II (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BONTRAGER
Suffix:II
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 1:124 N MILL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880-1521
Mailing Address - Country:US
Mailing Address - Phone:989-681-6693
Mailing Address - Fax:989-681-6693
Practice Address - Street 1:121 N MILL ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-1522
Practice Address - Country:US
Practice Address - Phone:989-681-6693
Practice Address - Fax:989-681-6693
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2301004464111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301004464Medicare PIN