Provider Demographics
NPI:1013224971
Name:BOLOS, ANTHONY PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PETER
Last Name:BOLOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 COMMONS DR W
Mailing Address - Street 2:UNIT 114
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-8423
Mailing Address - Country:US
Mailing Address - Phone:850-654-8770
Mailing Address - Fax:850-654-1056
Practice Address - Street 1:4014 COMMONS DR W
Practice Address - Street 2:UNIT 114
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8423
Practice Address - Country:US
Practice Address - Phone:850-654-8770
Practice Address - Fax:850-654-1056
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor