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General NPI Number Information
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NPI Number | 1740291426
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Entity Type | Individual
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Provider Name | GLENN E. BOLEY D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 506 E MAIN ST
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City | LOUISA
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State | VA
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Zip | 23093-4100
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Country | US
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Telephone | 540-967-2522
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Fax | 540-967-5878
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Provider Business Mailing Address
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Address Line | 506 E MAIN ST
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City | LOUISA
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State | VA
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Zip | 23093-4100
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Country | US
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Telephone | 540-967-2522
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Fax | 540-967-5878
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104000734
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License Number State | VA
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