Provider Demographics
NPI:1821427774
Name:BOLAND, ERICA (DC)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:BOLAND
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 1:920 W CITY HIGHWAY 16
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-1951
Mailing Address - Country:US
Mailing Address - Phone:608-498-4669
Mailing Address - Fax:
Practice Address - Street 1:920 W CITY HIGHWAY 16
Practice Address - Street 2:SUITE A
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-1951
Practice Address - Country:US
Practice Address - Phone:608-498-4669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4967-12111N00000X
WI313-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No176B00000XOther Service ProvidersMidwife