1912220146 NPI number — ONTARIO FAMILY CHIROPRACTIC P.C.

Table of content: DR. JACK WESLEY BOLING JR. DPT (NPI 1093024630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912220146 NPI number — ONTARIO FAMILY CHIROPRACTIC P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONTARIO FAMILY CHIROPRACTIC P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912220146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1422 NYS ROUTE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14519-9561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-524-2835
Provider Business Mailing Address Fax Number:
315-524-3164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1422 NYS ROUTE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONTARIO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14519-9561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-524-2835
Provider Business Practice Location Address Fax Number:
315-524-3164
Provider Enumeration Date:
03/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KOWALYK
Authorized Official First Name:
TEON
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
CHIROPRACTOR/OWNER
Authorized Official Telephone Number:
315-524-2835

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X011472-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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