Provider Demographics
NPI:1619041928
Name:BOLERJACK, PATRICK EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:EDWARD
Last Name:BOLERJACK
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 1:4503 CLEARVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2307
Mailing Address - Country:US
Mailing Address - Phone:504-885-9700
Mailing Address - Fax:504-885-8760
Practice Address - Street 1:4503 CLEARVIEW PKWY
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2307
Practice Address - Country:US
Practice Address - Phone:504-885-9700
Practice Address - Fax:504-885-8760
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1935697Medicaid
LA1935697Medicaid
59387Medicare ID - Type Unspecified