Individual
MR. TERRY JOE BONEBRAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CARE MANAGER/QIDP
Contact information
Practice address
2228 SANDSTONE DR, JENISON, MI 49428-7769
(616) 204-1571
Mailing address
2228 SANDSTONE DR, JENISON, MI 49428-7769
(616) 204-1571
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
374J00000X
Doula
—
—
374K00000X
Religious Nonmedical Practitioner
—
—
Other
Enumeration date
04/01/2022
Last updated
04/01/2022
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