Provider Demographics
NPI:1538132329
Name:BOLLIN, JEREMY DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DOUGLAS
Last Name:BOLLIN
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 1:212 PLYMOUTH ST SW
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3441
Mailing Address - Country:US
Mailing Address - Phone:712-546-7789
Mailing Address - Fax:712-546-6554
Practice Address - Street 1:212 PLYMOUTH ST SW
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3441
Practice Address - Country:US
Practice Address - Phone:712-546-7789
Practice Address - Fax:712-546-6554
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0460758Medicaid
IA0460758Medicaid
IAU99980Medicare UPIN