Provider Demographics
NPI:1235632431
Name:BONHAM, ERIC JAMES (LMT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:BONHAM
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 S JACKSON ST STE 1005
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3809
Mailing Address - Country:US
Mailing Address - Phone:720-933-0551
Mailing Address - Fax:303-484-2860
Practice Address - Street 1:1776 S JACKSON ST STE 1005
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3809
Practice Address - Country:US
Practice Address - Phone:720-933-0551
Practice Address - Fax:303-484-2860
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0016674225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist