Provider Demographics
NPI:1649403239
Name:BOLOGNA, PAUL JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:BOLOGNA
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 1:1924 HILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1740
Mailing Address - Country:US
Mailing Address - Phone:650-344-3495
Mailing Address - Fax:
Practice Address - Street 1:2041 PIONEER CT
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1786
Practice Address - Country:US
Practice Address - Phone:650-344-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0222900Medicare PIN
CAU39518Medicare UPIN