Provider Demographics
NPI:1568550473
Name:BOLLINGER, JENNIFER KELLY (DC, LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KELLY
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:TREXLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18087-0096
Mailing Address - Country:US
Mailing Address - Phone:973-769-5294
Mailing Address - Fax:
Practice Address - Street 1:8026 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-1219
Practice Address - Country:US
Practice Address - Phone:610-395-5509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA009795111N00000X
PA000924171100000X
NYX011398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist