Organization
FIRST CARE REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVE BONFESUTO DC (OWNER)
(214) 335-5870
Entity
Organization
Contact information
Practice address
11317 N CENTRAL EXPY, DALLAS, TX 75243-6703
(214) 335-5870
Mailing address
PO BOX 9, FRISCO, TX 75034-0001
(214) 335-5870
(972) 559-1769
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
9057
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
BCBS
—
Enumeration date
12/19/2007
Last updated
12/19/2007
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