Provider Demographics
NPI:1235437104
Name:BOLTON FAMILY CHIROPRACTIC LTD
Entity Type:Organization
Organization Name:BOLTON FAMILY CHIROPRACTIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE AND PATIENT BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:LIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:159-999-7903
Mailing Address - Street 1:1154 BRUNSWICK LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8900
Mailing Address - Country:US
Mailing Address - Phone:815-999-7903
Mailing Address - Fax:815-782-4414
Practice Address - Street 1:320 S BUDLER RD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-4327
Practice Address - Country:US
Practice Address - Phone:815-999-7903
Practice Address - Fax:815-782-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL589830Medicare PIN
ILU81200Medicare UPIN