Provider Demographics
NPI:1376693465
Name:BOLINGER, DAVID LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:BOLINGER
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 1:12439 GARRETT HWY
Mailing Address - Street 2:P.O. BOX 488
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1158
Mailing Address - Country:US
Mailing Address - Phone:301-334-1122
Mailing Address - Fax:301-334-6922
Practice Address - Street 1:12439 GARRETT HWY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1158
Practice Address - Country:US
Practice Address - Phone:301-334-1122
Practice Address - Fax:301-334-6922
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01129111N00000X, 111NR0400X
WV282111N00000X, 111NR0400X
PADC001905L111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation