Provider Demographics
NPI:1164731741
Name:BONSTEEL, KIM (LAC)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:
Last Name:BONSTEEL
Suffix:
Gender:M
Credentials:LAC
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 304
Mailing Address - Street 2:
Mailing Address - City:SAPPHIRE
Mailing Address - State:NC
Mailing Address - Zip Code:28774-0304
Mailing Address - Country:US
Mailing Address - Phone:828-526-0743
Mailing Address - Fax:828-862-3335
Practice Address - Street 1:348 S 5TH ST # 224
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28741-7002
Practice Address - Country:US
Practice Address - Phone:828-526-0743
Practice Address - Fax:828-862-3335
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC564171100000X
174H00000X, 175F00000X
NC4091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist