Provider Demographics
NPI:1649272543
Name:BOLTON, BRETT D (DC)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:D
Last Name:BOLTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10777 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5971
Mailing Address - Country:US
Mailing Address - Phone:425-454-2311
Mailing Address - Fax:425-462-5034
Practice Address - Street 1:10777 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5971
Practice Address - Country:US
Practice Address - Phone:425-454-2311
Practice Address - Fax:425-462-5034
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU41047Medicare UPIN
WAGAB22705Medicare PIN