Provider Demographics
NPI:1689683708
Name:BOLINGER, CHRISTINA M (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:M
Last Name:BOLINGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:SAUDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:16505 PINE RIDGE PASS
Mailing Address - Street 2:
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765-9213
Mailing Address - Country:US
Mailing Address - Phone:260-338-0924
Mailing Address - Fax:
Practice Address - Street 1:1114 W COOK RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-3214
Practice Address - Country:US
Practice Address - Phone:260-483-5588
Practice Address - Fax:260-489-1819
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN350037863OtherRAIL ROAD MEDICARE
IN668200Medicare ID - Type Unspecified
INU-58337Medicare UPIN