Provider Demographics
NPI:1326213422
Name:BOLTON, PAUL KENT (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENT
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 1:1144 COACH CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-3008
Mailing Address - Country:US
Mailing Address - Phone:408-644-9011
Mailing Address - Fax:408-677-4840
Practice Address - Street 1:1144 COACH CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-3008
Practice Address - Country:US
Practice Address - Phone:408-644-9011
Practice Address - Fax:408-677-4840
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor