Provider Demographics
NPI:1891173621
Name:BOLINGER, MARK A (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BOLINGER
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 1:81 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1434
Mailing Address - Country:US
Mailing Address - Phone:609-526-5652
Mailing Address - Fax:609-526-4022
Practice Address - Street 1:81 SOMERSET DR
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1434
Practice Address - Country:US
Practice Address - Phone:609-526-5652
Practice Address - Fax:609-526-4022
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00349500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor