Provider Demographics
NPI:1952389652
Name:BOLIN, DARRELL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:JAMES
Last Name:BOLIN
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 1:1401R MOUNT ROYAL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-2205
Mailing Address - Country:US
Mailing Address - Phone:412-487-6266
Mailing Address - Fax:412-487-6494
Practice Address - Street 1:1401R MOUNT ROYAL BLVD
Practice Address - Street 2:
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-2205
Practice Address - Country:US
Practice Address - Phone:412-487-6266
Practice Address - Fax:412-487-6494
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002726L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA202050OtherUPMC
PA609468300OtherACS DEPT.OF LABOR
PA4492628OtherCIGNA
PA154918OtherHIGHMARK
PA1020311Medicaid
PA525468OtherAETNA HMO
PA350009360OtherRAILROAD MEDICARE
PA5722287OtherAETNA PPO
PA350009360OtherRAILROAD MEDICARE
PA525468OtherAETNA HMO