Provider Demographics
NPI:1356580856
Name:KRISTEN BOHNET, DC, LAC, ACUPUNCTURE CORPORATION
Entity type:Organization
Organization Name:KRISTEN BOHNET, DC, LAC, ACUPUNCTURE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHNET
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:760-771-2332
Mailing Address - Street 1:79440 HIGHWAY 111
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4500
Mailing Address - Country:US
Mailing Address - Phone:760-771-2332
Mailing Address - Fax:760-771-2316
Practice Address - Street 1:79440 HIGHWAY 111
Practice Address - Street 2:SUITE 104
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4500
Practice Address - Country:US
Practice Address - Phone:760-771-2332
Practice Address - Fax:760-771-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-07
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8325171100000X
CADC27563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty