Provider Demographics
NPI:1871647776
Name:BOLTON CHIROPRACTIC CENTER PSC
Entity Type:Organization
Organization Name:BOLTON CHIROPRACTIC CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:1859-277-5077
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6063701Medicare ID - Type Unspecified