Provider Demographics
NPI:1033272190
Name:BONAR, KELLY THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:THOMAS
Last Name:BONAR
Suffix:
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:PO BOX 262
Mailing Address - Street 2:208 FRANKLIN STREET
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213
Mailing Address - Country:US
Mailing Address - Phone:319-849-1064
Mailing Address - Fax:319-849-1732
Practice Address - Street 1:208 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:IA
Practice Address - Zip Code:52213
Practice Address - Country:US
Practice Address - Phone:319-849-1064
Practice Address - Fax:319-849-1732
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1286203Medicaid
T87204Medicare UPIN
IA05061Medicare ID - Type Unspecified