Provider Demographics
NPI:1932440377
Name:BOLSENBROEK, JODI (DC)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:
Last Name:BOLSENBROEK
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:PO BOX 1012
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-1012
Mailing Address - Country:US
Mailing Address - Phone:845-928-2225
Mailing Address - Fax:845-928-1080
Practice Address - Street 1:489 STATE ROUTE 32
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-3305
Practice Address - Country:US
Practice Address - Phone:845-928-2225
Practice Address - Fax:845-928-1080
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011412-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor