Provider Demographics
NPI:1619902798
Name:BOHNET, KRISTEN LEE (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LEE
Last Name:BOHNET
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72855 FRED WARING DR
Mailing Address - Street 2:SUITE C-20
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-9367
Mailing Address - Country:US
Mailing Address - Phone:760-836-3644
Mailing Address - Fax:760-836-1914
Practice Address - Street 1:72855 FRED WARING DR
Practice Address - Street 2:SUITE C-20
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9367
Practice Address - Country:US
Practice Address - Phone:760-836-3644
Practice Address - Fax:760-836-1914
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27563111N00000X
CAAC8325171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0275630Medicare ID - Type UnspecifiedCHIROPRACTIC