Provider Demographics
NPI:1740956317
Name:BOLLING, JEFFREY (NMD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:BOLLING
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-4522
Mailing Address - Country:US
Mailing Address - Phone:205-702-6209
Mailing Address - Fax:813-436-8756
Practice Address - Street 1:122 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-4522
Practice Address - Country:US
Practice Address - Phone:205-702-6209
Practice Address - Fax:813-436-8756
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12744175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath