Provider Demographics
NPI:1376794586
Name:BOLTON, ANGELA (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:BOLTON-SKYBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:717 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1924
Mailing Address - Country:US
Mailing Address - Phone:650-726-8390
Mailing Address - Fax:
Practice Address - Street 1:717 MAIN ST
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1924
Practice Address - Country:US
Practice Address - Phone:650-726-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor