Provider Demographics
NPI:1649229386
Name:BOLTON, JOEL D (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
Last Name:BOLTON
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 1:1154 BRUNSWICK LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8900
Mailing Address - Country:US
Mailing Address - Phone:630-746-4240
Mailing Address - Fax:
Practice Address - Street 1:320 S BUDLER RD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-4327
Practice Address - Country:US
Practice Address - Phone:815-999-7903
Practice Address - Fax:815-782-4414
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL589830Medicare ID - Type Unspecified
ILU81200Medicare UPIN