Provider Demographics
NPI:1083807614
Name:BOLTON, TIMOTHY (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BOLTON
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 1:1605 ROCK PRAIRIE RD STE 222
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8358
Mailing Address - Country:US
Mailing Address - Phone:979-696-1996
Mailing Address - Fax:979-694-2788
Practice Address - Street 1:1605 ROCK PRAIRIE RD STE 222
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8358
Practice Address - Country:US
Practice Address - Phone:979-696-1995
Practice Address - Fax:979-694-2788
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor