Provider Demographics
NPI:1508847146
Name:BOLERA, DAYNA L (DC)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:L
Last Name:BOLERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DAYNA
Other - Middle Name:L
Other - Last Name:BOLLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:215 E FOREST AVENUE
Mailing Address - City:SOUTH LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45065-0210
Mailing Address - Country:US
Mailing Address - Phone:513-480-4491
Mailing Address - Fax:513-480-4493
Practice Address - Street 1:215 E FOREST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45065-1311
Practice Address - Country:US
Practice Address - Phone:513-480-4491
Practice Address - Fax:513-480-4493
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0942387Medicaid
OH462228268052OtherCARESOURCE
OH0942387Medicaid
OH462228268052OtherCARESOURCE
OHBO4071711Medicare ID - Type UnspecifiedMEDICARE