Provider Demographics
NPI:1558776724
Name:BOLLMAN, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BOLLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VISTA MONTANA
Mailing Address - Street 2:APT 2444
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 VISTA MONTANA
Practice Address - Street 2:APT 2444
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-2718
Practice Address - Country:US
Practice Address - Phone:408-773-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor