Provider Demographics
NPI:1417954033
Name:BOLKS, PEGGY J (DC)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:J
Last Name:BOLKS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18468 KUYKENDAHL RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8123
Mailing Address - Country:US
Mailing Address - Phone:281-651-0220
Mailing Address - Fax:281-288-6100
Practice Address - Street 1:18468 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8123
Practice Address - Country:US
Practice Address - Phone:281-651-0220
Practice Address - Fax:281-288-6100
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-29
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7099111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTO4928Medicare UPIN
TX605714Medicare ID - Type Unspecified