Healthcare Provider Details

I. General information

NPI: 1376461095
Provider Name (Legal Business Name): REBECCA BOLDT DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 GRINDSTONE PLAZA DR STE 109
COLUMBIA MO
65201-3794
US

IV. Provider business mailing address

1413 GRINDSTONE PLAZA DR STE 109
COLUMBIA MO
65201-3794
US

V. Phone/Fax

Practice location:
  • Phone: 573-476-1000
  • Fax: 573-256-7378
Mailing address:
  • Phone: 573-476-1000
  • Fax: 573-256-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2025008531
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: