Provider Demographics
NPI:1831843697
Name:BOLEWARE, REBECCA (DC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:BOLEWARE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 AMETHYST AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7838
Mailing Address - Country:US
Mailing Address - Phone:682-365-7872
Mailing Address - Fax:
Practice Address - Street 1:900 AMETHYST AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-7838
Practice Address - Country:US
Practice Address - Phone:682-365-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor