Healthcare Provider Details

I. General information

NPI: 1376794586
Provider Name (Legal Business Name): ANGELA BOLTON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA BOLTON-SKYBA D.C.

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 MAIN ST
HALF MOON BAY CA
94019-1924
US

IV. Provider business mailing address

717 MAIN ST
HALF MOON BAY CA
94019-1924
US

V. Phone/Fax

Practice location:
  • Phone: 650-726-8390
  • Fax:
Mailing address:
  • Phone: 650-726-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: