Provider Demographics
NPI:1992886121
Name:BOLTON, COY ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:COY
Middle Name:ANTHONY
Last Name:BOLTON
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 1:1401 HILLYER ROBINSON PKWY
Mailing Address - Street 2:STE A
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-6707
Mailing Address - Country:US
Mailing Address - Phone:256-835-3511
Mailing Address - Fax:256-835-4931
Practice Address - Street 1:1401 HILLYER ROBINSON PKW
Practice Address - Street 2:SUITE A
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207
Practice Address - Country:US
Practice Address - Phone:256-835-3511
Practice Address - Fax:256-835-4931
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU63171Medicare UPIN