Provider Demographics
NPI:1720525082
Name:BOLGER, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BOLGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5174
Mailing Address - Street 2:
Mailing Address - City:SNOWMASS VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:81615-5174
Mailing Address - Country:US
Mailing Address - Phone:603-491-7629
Mailing Address - Fax:
Practice Address - Street 1:1280 S UTE AVE # 1
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-2126
Practice Address - Country:US
Practice Address - Phone:970-710-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11936111N00000X
COCHR.0009700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty