Provider Demographics
NPI:1225551815
Name:BOLTON, LUCY (LMT)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5746
Mailing Address - Country:US
Mailing Address - Phone:843-571-1020
Mailing Address - Fax:843-573-0788
Practice Address - Street 1:1001 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5746
Practice Address - Country:US
Practice Address - Phone:843-571-1020
Practice Address - Fax:843-573-0788
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3466225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1700848959OtherCHIROPRACTIC