Provider Demographics
NPI:1821514928
Name:BOLAR, RONNIE EARL (DC)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:EARL
Last Name:BOLAR
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 1:865 THORNTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-505-3765
Practice Address - Street 1:865 THORNTON RD STE B
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2607
Practice Address - Country:US
Practice Address - Phone:334-321-7275
Practice Address - Fax:888-505-3765
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor