Provider Demographics
NPI:1396730768
Name:BOLZ, SCOTT T (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:BOLZ
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 1:19510 KUYKENDAHL RD # A
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3408
Mailing Address - Country:US
Mailing Address - Phone:281-651-7111
Mailing Address - Fax:281-288-9550
Practice Address - Street 1:19510 KUYKENDAHL RD # A
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3408
Practice Address - Country:US
Practice Address - Phone:281-651-7111
Practice Address - Fax:281-288-9550
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6962DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89770YOtherBC / BS
TX00278YMedicare ID - Type UnspecifiedMEDICARE
TX89770YOtherBC / BS