MEDICARE: BONNIE KOENIG LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	00000561	WA

General Provider Information

NPI Number	:	1770631954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE KOENIG LAC

Provider Business Mailing Address
First Line	:	22914 NE 24TH PL
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-6526
Country	:	US
Telephone Number	:	425-888-1018
Fax Number	:	425-888-0636

Provider Business Practice Location Address
First Line	:	231 BENDIGO BLVD N
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8259
Country	:	US
Telephone Number	:	425-888-1018
Fax Number	:	425-888-0636

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	07/08/2007

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