Provider Demographics
NPI:1386450732
Name:RIVERA BONILLA, EFRAIN (DC)
Entity type:Individual
Prefix:
First Name:EFRAIN
Middle Name:
Last Name:RIVERA BONILLA
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 YORK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-2355
Mailing Address - Country:US
Mailing Address - Phone:336-882-2434
Mailing Address - Fax:
Practice Address - Street 1:1623 YORK AVE STE 101
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2355
Practice Address - Country:US
Practice Address - Phone:336-882-2434
Practice Address - Fax:336-882-4747
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor