Provider Demographics
NPI:1740291426
Name:BOLEY, GLENN E (DC)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:E
Last Name:BOLEY
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 1:506 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-4100
Mailing Address - Country:US
Mailing Address - Phone:540-967-2522
Mailing Address - Fax:540-967-5878
Practice Address - Street 1:506 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093-4100
Practice Address - Country:US
Practice Address - Phone:540-967-2522
Practice Address - Fax:540-967-5878
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT94040Medicare UPIN
VA190000918Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER