Provider Demographics
NPI:1063542470
Name:BOUNTING, KELLY L
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:BOUNTING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:19950 SOUTH PRAIRIE RD
Mailing Address - Street 2:HENSCHELL CHIROPRACTIC
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7901
Mailing Address - Country:US
Mailing Address - Phone:253-862-1555
Mailing Address - Fax:253-862-1557
Practice Address - Street 1:19950 SOUTH PRAIRIE RD
Practice Address - Street 2:HENSCHELL CHIROPRACTIC
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7901
Practice Address - Country:US
Practice Address - Phone:253-862-1555
Practice Address - Fax:253-862-1557
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012445174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist