MEDICARE: DR. DARRELL JAMES BOLIN D.C.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC002726L	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	350009360	OTHER	PA	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202050	OTHER	PA	UPMC
2	609468300	OTHER	PA	ACS DEPT.OF LABOR
3	4492628	OTHER	PA	CIGNA
4	154918	OTHER	PA	HIGHMARK
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	525468	OTHER	PA	AETNA HMO
8	5722287	OTHER	PA	AETNA PPO

NPI Number	:	1952389652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRELL JAMES BOLIN D.C.

Provider Business Mailing Address
First Line	:	1401R MOUNT ROYAL BLVD
Second Line	:
City	:	GLENSHAW
State	:	PA
Zip	:	15116-2205
Country	:	US
Telephone Number	:	412-487-6266
Fax Number	:	412-487-6494

Provider Business Practice Location Address
First Line	:	1401R MOUNT ROYAL BLVD
Second Line	:
City	:	GLENSHAW
State	:	PA
Zip	:	15116-2205
Country	:	US
Telephone Number	:	412-487-6266
Fax Number	:	412-487-6494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	11/04/2010

2205 MT ROYAL BLVD
GLENSHAW, PA
15116

Practice Phone: 724-494-3105
Practice Fax: