Provider Demographics
NPI:1295807600
Name:BOLAND, MATTHEW STEPHEN (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STEPHEN
Last Name:BOLAND
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 1:915 NORTH MOUNTAIN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112
Mailing Address - Country:US
Mailing Address - Phone:717-652-5550
Mailing Address - Fax:717-652-2488
Practice Address - Street 1:915 NORTH MOUNTAIN RD
Practice Address - Street 2:SUITE C
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112
Practice Address - Country:US
Practice Address - Phone:717-652-5550
Practice Address - Fax:717-652-2488
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA003322-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4539759OtherAETNA
PA5712090001OtherMEDICARE/DME
PAT30626Medicare UPIN
PA4539759OtherAETNA
PA5712090001Medicare UPIN
PA5712090001Medicare NSC