Provider Demographics
NPI:1154836054
Name:LOYOLA CHIROPRACTIC, DR. BOLLMAN & DR. MARTIN, INC.
Entity Type:Organization
Organization Name:LOYOLA CHIROPRACTIC, DR. BOLLMAN & DR. MARTIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BOLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-599-4637
Mailing Address - Street 1:1000 FREMONT AVE STE 155
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6049
Mailing Address - Country:US
Mailing Address - Phone:408-773-9165
Mailing Address - Fax:
Practice Address - Street 1:1000 FREMONT AVE STE 155
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6049
Practice Address - Country:US
Practice Address - Phone:408-773-9165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty