Provider Demographics
NPI:1801852298
Name:BOLTON, KATHRYN A (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:A
Last Name:BOLTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 W LOWRY LN
Mailing Address - Street 2:SUITE 164
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3018
Mailing Address - Country:US
Mailing Address - Phone:859-277-5077
Mailing Address - Fax:
Practice Address - Street 1:171 W LOWRY LN
Practice Address - Street 2:SUITE 164
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3018
Practice Address - Country:US
Practice Address - Phone:859-277-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6063701Medicare PIN