Healthcare Provider Details

I. General information

NPI: 1811063993
Provider Name (Legal Business Name): DAVID ERIC BOLL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 E NORTHLAND AVE
APPLETON WI
54911-8415
US

IV. Provider business mailing address

1223 E NORTHLAND AVE
APPLETON WI
54911-8415
US

V. Phone/Fax

Practice location:
  • Phone: 920-886-5008
  • Fax:
Mailing address:
  • Phone: 920-886-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2759-012
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2301008871
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: